Asymptomatic ventricular fibrillation in continuous flow left-ventricular assist device

Left ventricular assist devices (LVADs) have increased survival for heart failure patients. Individuals with LVADs are a growing patient population with frequent complications and Emergency Department (ED) visits. A 50-year-old female presented to the ED due to a low flow alarm on her LVAD. Upon arrival in the ED she was noted to be in ventricular fibrillation. She was defibrillated with restoration to normal sinus rhythm and was started on amiodarone. An implantable cardiac defibrillator was placed during hospital admission. Amiodarone was continued as an outpatient. Patients with continuous flow LVADs can be in dysrhythmias including ventricular tachycardia and ventricular fibrillation and remain relatively asymptomatic. We present a rare case of a patient with an LVAD and ventricular fibrillation who was completely asymptomatic in the ED.