ECG inerpratation with VAD

[yappy]

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Hello all,

What is the value of ECG interpretation with a pt who has a VAD? Specifically, does the device influence the rhythm; and, are ECG changes important to clinical decision making when a pt has a VAD. Does anyone know of any resources regarding ECG interpretation when a patient has a VAD.

I saw a pt with a VAD who had a wide complex rhythm - similar to accelerated idioventricular. However, my understanding is that the VAD essentially bypasses the left ventricle. What gives?

Like the tag says I'm pre-health. Sorry if my questions seem domestic.

Thanks.

 

[EPADHA]

Hello all,

What is the value of ECG interpretation with a pt who has a VAD? Specifically, does the device influence the rhythm; and, are ECG changes important to clinical decision making when a pt has a VAD. Does anyone know of any resources regarding ECG interpretation when a patient has a VAD.

I saw a pt with a VAD who had a wide complex rhythm - similar to accelerated idioventricular. However, my understanding is that the VAD essentially bypasses the left ventricle. What gives?

Like the tag says I'm pre-health. Sorry if my questions seem domestic.

Thanks.

LVADs dont influence underlying rhythm. Every patient is different-you may see people in VT/idioventricular rhythm with LVADs in place who are doing well. I have heard of one patient who would go in to VF; and wd be doing okay till his ICD wd shock him. When they transplanted him, he wanted to kiss his VAD pump, but shoot his ICD 🙂
However, if their RV decompensates in the setting of ventricular rhythm or LV filling is compromised, things may head south.

 

[Dreemer005]

Hello all,

What is the value of ECG interpretation with a pt who has a VAD? Specifically, does the device influence the rhythm; and, are ECG changes important to clinical decision making when a pt has a VAD. Does anyone know of any resources regarding ECG interpretation when a patient has a VAD.

I saw a pt with a VAD who had a wide complex rhythm - similar to accelerated idioventricular. However, my understanding is that the VAD essentially bypasses the left ventricle. What gives?

Like the tag says I'm pre-health. Sorry if my questions seem domestic.

Thanks.

In general, most patients who have a VAD have significant underlying cardiomyopathy and most likely, associated arrhythmias. Due to this, VT/VF are common, as is atrial fibrillation. A VAD itself can trigger an arrhythmia due to local scar formation at the site of the outflow cannula. Most intermediate-to-long term devices are implanted in the ventricle and can predispose to further VT/VF. Most short term devices (i.e. centrimag in adults) are implanted in atria and can predispose to afib, conversely.

Patients who go into VT/VF with a LVAD are still fully supported on the left side. Typically they won't completely crash but will often feel horrible due to decreased forward flow/preload since the RV has no support (unless the patient has a RVAD also).

So the patient you saw in VT was probably really in VT. It probably won't kill them acutely, but will make them hypotensive and symptomatic. At our institution, we routinely implant ICD's even after LVAD implantation for any patients with documented VT for this reason.