Ineffective ICD Shocks for Ventricular Fibrillation in a Patient with a Left Ventricular Assist Device: Continuous Flow During the Electrical Storm

Ventricular arrhythmias are life-threatening and can serve as a precursor to sudden death. They are a common presentation in patients with severely reduced left ventricular (LV) function. The use of an implantable cardioverter defibrillator (ICD) is seen as an acceptable therapy against malignant ventricular arrhythmias. In patients with LV heart failure, a left ventricular assist device (LVAD) can provide pulsatile flow to mimic the cardiac systolic and diastolic function. We report a case of a 38-year-old male with a LVAD who presented to the emergency department due to syncope and frequent ICD discharges. There were documented episodes of ventricular fibrillation and a failed defibrillator threshold test.