Pulmonary arterial pressure sensing in a patient with left ventricular assist device during ventricular arrhythmia

Introduction With the ever-increasing heart failure population, the use of left ventricular assist devices (LVAD) is becoming increasingly more accepted as a treatment for heart failure as destination therapy. In 2013, this became an American Heart Association recommendation as destination therapy. Despite improved mechanical function, the problem of fluid management often persists for these patients. Patients can have problems with volume overload, but in addition they are sensitive to volume and filling pressure reduction. Readmissions among patients with an LVAD remain high, with heart failure as a common indication. In addition, these patients are still prone to ventricular arrhythmias (VA). Patients with LVAD have a high incidence of VA and have been shown to have an improved mortality when treated with an implantable cardioverter-defibrillator (ICD). Fluid management in patients with symptomatic congestive heart failure is improved when guided by pulmonary artery (PA) pressure sensor measurements. There is scant data of this use in the LVAD population, but limited data suggest some utility. Patients with an LVAD often have very depressed left ventricular function and blunted pulse pressure, as the left-sided cardiac output is driven by the LVAD. However, patients may still have intact right ventricular (RV) function that generates a significant pulse pressure in the pulmonary artery. Thus, ambulatory PA pressure measurements may serve as an ambulatory marker of RV function. We hypothesize that PA pressure measurements could be used as a surrogate for RV function and thus hemodynamic stability during VA. If so, could these data be utilized to enhance detection in patients with LVAD support and an ICD?