Arrhythmias

Atrial Fibrillation

Common and may result in haemodynamic instability and like in normal patients may be well tolerated or result in haemodynamic instability

Ventricular arrhythmias: (VT and VF)

VT is common and again may be well tolerated. 

VF is often a terminal event but a small percentage of patients can tolerate it – these patients may be alert and talking. 

Ventricular arrhythmias may be due to:

• Underlying scar
• Suction events (Mechanical sucking down of left ventricle from inflow cannula) related to reduced flow to LV such as in RV failure, hypovolaemia, elevated PA pressures
• Dilating RV

Ventricular arrhythmias are better tolerated in LVAD patients due to the physiological support provided by the VAD. 

Persistent arrhythmias or repeated RV fibrillation can compromise RV function – remember the importance of RV function on VAD mechanics. 

Learning bite

The LVAD is only as good as your RV.