• Images in cardiology

Our pictures demonstrate one instance in which intractable fast ventricular tachycardia is neither fatal nor haemodynamically significant.

Our patient was a 59 year old man who was considered unsuitable for an acute heart transplant due to multi-organ failure following an extensive anterior myocardial infarction. He was on maximal medical treatment including intra-aortic balloon pump support. Ventricular tachycardias were noted on admission. Following successful implantation of a biventricular assist device (Thoratec, USA) he developed intractable ventricular tachycardia (refractory to antiarrhythmic therapy and DC cardioversion). Despite this usually fatal persistent arrhythmia, he was able to rehabilitate normally. This phenomenon was possible only because of his mechanical biventricular support. This also facilitated sufficient improvement in his haemodynamic, ventilatory, and nutritional status such that he underwent a heart and kidney transplant four months after his initial presentation.

Patient on exercise bicycle (left) and at rest (right). Inset: Underlying rhythm of ventricular tachycardia on ECG monitor. The exposed extra-corporeal ventricular assist devices are seen resting on the patient's abdomen. The portable ventricular device console is present on the left. A haemofiltration catheter is visible on the right side of the patient's neck. The motion artefact seen on the monitor in the main picture is abolished in the inset picture taken at rest.

Implantation of ventricular assist devices as a bridge to transplantation or recovery is predominantly for intractable heart failure. Biventricular assist devices account for approximately 20% of these procedures. Significant ventricular arrhythmias are rare following such operations, but they can result in abnormal pump performance, embolic phenomena, and may result in dehiscence of the pump anastomoses. Our patient had none of these complications. We demonstrate the potential of this treatment in selected patients with haemodynamically significant arrhythmias unsuitable for implantable cardioverter-defibrillators.