Effect of counter-pulsation control of a pulsatile left ventricular assist device on working load variations of the native heart

BackgroundWhen using a pulsatile left ventricular assist device (LVAD), it is important to reduce the cardiac load variations of the native heart because severe cardiac load variations can induce ventricular arrhythmia. In this study, we investigated the effect of counter-pulsation control of the LVAD on the reduction of cardiac load variation.MethodsA ventricular electrocardiogram-based counter-pulsation control algorithm for a LVAD was implemented, and the effects of counter-pulsation control of the LVAD on the reduction of the working load variations of the left ventricle were determined in three animal experiments.ResultsDeviations of the working load of the left ventricle were reduced by 51.3%, 67.9%, and 71.5% in each case, and the beat-to-beat variation rates in the working load were reduced by 84.8%, 82.7%, and 88.2% in each ease after counter-pulsation control. There were 3 to 12 premature ventricle contractions (PVCs) before counter-pulsation control, but no PVCs were observed during counter-pulsation control.ConclusionsCounter-pulsation control of the pulsatile LVAD can reduce severe cardiac load variations, but the average working load is not markedly affected by application of counter-pulsation control because it is also influenced by temporary cardiac outflow variations. We believe that counter-pulsation control of the LVAD can improve the long-term safety of heart failure patients equipped with LVADs.

[1]  Susan Chambers,et al.  Prolonged repolarization after ventricular assist device support is associated with arrhythmias in humans with congestive heart failure. , 2005, Journal of cardiac failure.

[2]  Mark Plunkett,et al.  Successful use of a pneumatic biventricular assist device as a bridge to transplantation in cardiogenic shock. , 2011, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[3]  David T Huang,et al.  Risk of Mortality for Ventricular Arrhythmia in Ambulatory LVAD Patients , 2012, Journal of cardiovascular electrophysiology.

[4]  K. Sun,et al.  Development of Counterpulsation Algorithm for a Moving-actuator Type Pulsatile LVAD , 2004, The International journal of artificial organs.

[5]  Willis J. Tompkins,et al.  A Real-Time QRS Detection Algorithm , 1985, IEEE Transactions on Biomedical Engineering.

[6]  D. Kass,et al.  Sudden cardiac death in heart failure. The role of abnormal repolarization. , 1994, Circulation.

[7]  Gopi Dandamudi,et al.  Endocardial catheter ablation of ventricular tachycardia in patients with ventricular assist devices. , 2007, Heart rhythm.

[8]  Seong Wook Choi,et al.  Development of a Pacemaker with a Ventricular Assist Device for End-Stage Heart Failure Patients , 2011 .

[9]  Marc A Simon,et al.  Survival benefit of implantable cardioverter-defibrillators in left ventricular assist device-supported heart failure patients. , 2012, Journal of cardiac failure.

[10]  Yoshifumi Naka,et al.  Effects of left ventricular assist device therapy on ventricular arrhythmias. , 2005, Journal of the American College of Cardiology.

[11]  S. Gandhi,et al.  Mechanical Circulatory Support of the Critically Ill Child Awaiting Heart Transplantation , 2009, Current cardiology reviews.

[12]  D. Pennington,et al.  Importance of ventricular arrhythmias in bridge patients with ventricular assist devices. , 1991, ASAIO transactions.

[13]  M Kitamura,et al.  Direct Cardiac Potential Trigger for Chronic Control of a Ventricular Assist Device , 2001, ASAIO journal.

[14]  Seong Wook Choi,et al.  Blood Flow and Pressure Evaluation for a Pulsatile Conduit-Shaped Ventricular Assist Device with Structural Characteristic of Conduit Shape , 2011 .

[15]  Irmina Gradus-Pizlo,et al.  Ventricular arrhythmias in patients with implanted ventricular assist devices: a contemporary review. , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[16]  Willis J. Tompkins,et al.  Quantitative Investigation of QRS Detection Rules Using the MIT/BIH Arrhythmia Database , 1986, IEEE Transactions on Biomedical Engineering.

[17]  N. Smedira,et al.  Improved survival among ventricular assist device recipients with a concomitant implantable cardioverter-defibrillator. , 2010, Heart rhythm.

[18]  D. Pennington,et al.  Importance of ventricular arrhythmias in recovery patients with ventricular assist devices. , 1991, ASAIO transactions.

[19]  S. Cobbe,et al.  Arrhythmogenesis in experimental models of heart failure: the role of increased load. , 1996, Cardiovascular research.

[20]  Hillel Laks,et al.  Use of ventricular assist device as a bridge to cardiac transplantation: impact of age and other determinants on outcomes. , 2009, Texas Heart Institute journal.

[21]  John P. Gaughan,et al.  Electrophysiological Alterations After Mechanical Circulatory Support in Patients With Advanced Cardiac Failure , 2001, Circulation.

[22]  H T Davis,et al.  Ventricular Ectopic Beats and Their Relation to Sudden and Nonsudden Cardiac Death After Myocardial Infarction , 1979, Circulation.

[23]  Seong Wook Choi,et al.  Analysis of left ventricular impedance in comparison with ultrasound images. , 2012, Artificial organs.

[24]  Socrates Dokos,et al.  A method for control of an implantable rotary blood pump for heart failure patients using noninvasive measurements. , 2011, Artificial organs.

[25]  T. Korakianitis,et al.  Numerical simulation of cardiovascular dynamics with different types of VAD assistance. , 2007, Journal of biomechanics.