Prolonged asystole in a patient with an isolated left ventricular assist device
Prolonged asystole in a patient with an isolated left ventricular assist device
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DOI：
10.2217/fca-2016-0022
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发表时间：
2016-09-01
影响因子：
1.7
通讯作者：
Shaw, Steven M.
中科院分区：
文献类型：
--
作者：
Javed, Wasim;Chaggar, Parminder S.;Shaw, Steven M.
在终末期心力衰竭的治疗中，左心室辅助装置(LVAD)被公认为是心脏移植前或心肌恢复期间的一种有效治疗手段。尽管LVADs需要足够的左心室前负荷才能有效地增强全身循环，但很少有LVADs患者在持续的、通常是致命的心律失常中存活下来，例如室颤和停搏。虽然目前的报道描述了一名患有这种心律失常的LVAD患者存活了15天，但我们描述了一名患有LVAD的患者通过Fontan循环机制存活了104天的停搏，我们认为这是已知的持续致命心律失常的最长存活时间。此病例突出了LVAD支持的循环生理学，以及在管理非卧床LVAD患者时可能出现的独特挑战，如预测预后。鉴于LVAD越来越多地用于治疗终末期心力衰竭，这些问题在未来可能会变得更加频繁。
Left ventricular assist devices (LVADs) are well established in the management of end-stage heart failure as either destination therapy, a bridge prior to cardiac transplantation or during myocardial recovery. Despite LVADs requiring adequate left ventricular preload to effectively augment systemic circulation, there have been rare cases of patients with LVADs surviving sustained, normally fatal arrhythmias, such as ventricular fibrillation and asystole. Whilst current reports describe an LVAD patient surviving 15 days with such an arrhythmia, we describe the case of a patient with an LVAD surviving 104 days of asystole via a Fontan mechanism of circulation, which we believe is the longest known survival of a sustained fatal arrhythmia. This case highlights the physiology of circulations supported by LVADs and the unique challenges that may arise in managing ambulant LVAD patients, such as predicting prognosis. Given the increasing use of LVADs to treat end-stage heart failure, these issues are likely to become more frequently encountered in the future.