Incessant tachycardia in a patient with advanced heart failure and left ventricular assist device: What is the mechanism?

Amit Noheria; Siva K Mulpuru; Peter A Noseworthy; Samuel J Asirvatham

doi:10.1016/j.ipej.2016.04.001

Incessant tachycardia in a patient with advanced heart failure and left ventricular assist device: What is the mechanism?

Indian Pacing Electrophysiol J. 2016 Jan-Feb;16(1):34-9. doi: 10.1016/j.ipej.2016.04.001. Epub 2016 Apr 19.

Authors

Amit Noheria¹, Siva K Mulpuru², Peter A Noseworthy³, Samuel J Asirvatham⁴

Affiliations

¹ Cardiovascular Division, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8086, St. Louis, MO 63110, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. Electronic address: [email protected].
² Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. Electronic address: [email protected].
³ Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. Electronic address: [email protected].
⁴ Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. Electronic address: [email protected].

Abstract

We present a case of incessant wide-complex tachycardia in a patient with left-ventricular assist device, and discuss the differential diagnosis with an in-depth analysis of the intracardiac tracings during the invasive electrophysiologic study, including interpretation of the relative timing of the fascicular signals during tachycardia and in sinus rhythm, and interpretation of pacing and entrainment maneuvers.

Keywords: Bundle-branch reentry tachycardia; Entrainment; Left ventricular assist device; Ventricular tachycardia; Wide complex tachycardia.