Ventricular Fibrillation in a Left Ventricular Assist Device Patient: Can the echocardiogram be misleading?

Sustained ventricular tachycardia and ventricular fibrillation (VF) are life-threatening arrhythmias which remain highly prevalent in patients with advanced heart failure. These ventricular arrhythmias may impair the support provided by CF-LVADs and lead to frequent hospitalizations, antiarrhythmic medication use, external defibrillations, and need for heart transplantation. We report a case in which a patient with a CF-LVAD and an ICD at end-of-life (EOL) presented with asymptomatic low-flow alarms and was found to have VF of unknown duration. Unique in our case was the presence of organized contractility and rhythmic opening of the mitral valve on echocardiogram despite VF on ECG.