Left Ventricular Assist Device Thrombosis-Amiodarone-Induced Hyperthyroidism: Causal Link?

ASAIO J. 2019 Feb;65(2):e18-e20. doi: 10.1097/MAT.0000000000000773.

Abstract

Ventricular arrhythmias occurs in 20-50% of patients supported with left ventricular assist devices (LVAD). Ventricular arrhythmias are well tolerated with LVAD support but long-term consequences include worsening right ventricular function. Management of ventricular arrhythmias in LVAD patients includes use of antiarrhythmic agents or ablation. Amiodarone has been used a first-line agent to treat ventricular arrhythmias post-LVAD implantation. Chronic treatment with amiodarone for arrhythmias can result in hyperthyroidism and hypothyroidism in 5-10% of patients. Hyperthyroidism is known to cause endothelial dysfunction, alterations in coagulation, and fibrinolytic pathways favoring hypercoagulable state. We describe two cases of left ventricular assist device (LVAD) thrombosis potentiated by amiodarone-induced hyperthyroidism (AIT) and discuss pathophysiological mechanisms for hypercoagulable state induced by hyperthyroidism.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Amiodarone / adverse effects*
  • Anti-Arrhythmia Agents / adverse effects*
  • Arrhythmias, Cardiac / complications
  • Arrhythmias, Cardiac / drug therapy
  • Heart Failure / therapy
  • Heart-Assist Devices / adverse effects*
  • Humans
  • Hyperthyroidism / chemically induced*
  • Hyperthyroidism / complications
  • Male
  • Thrombosis / etiology*
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents
  • Amiodarone