Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Review

Volume 12, Number 4, August 2021, pages 219-224

Effect of Atrioventricular Dyssynchrony on Impella Hemodynamics: Mechanism and Its Clinical Implications

Figures

Figure 1.
Figure 1. Aortic pressure tracing with Impella mechanical circulatory support device. Intermittent significant drop in aortic pressures seen correlating with loss of AV synchrony (red arrows). Impella output improves significantly in beats with adequate AV synchrony (green arrows). AV: atrioventricular.
Figure 2.
Figure 2. Pulmonary artery pressure tracing with Impella mechanical circulatory support device. Pulmonary artery pressure drops significantly with loss of AV synchrony (red arrows) and improves intermittently with synchronous paced beats (green arrows). This indicates that loss of AV synchrony in single chamber paced rhythm in complete heart block can affect RV cardiac output which can indirectly affect Impella output causing “low volume-low Impella output syndrome”. AV: atrioventricular; RV: right ventricular.

Tables

Table 1. Factors Reported by Various Studies Which Can Affect Impella Hemodynamics
 
StudyStudy typeNo. of patientsType(s) of ImpellaFactors
Khalid et al [26]Observational, retrospective study407Impella CP (53.6%); Impella 2.5 (20.1%); Impella 5.0 (11.5%); Impella LD (0.2%); unspecified (14.5%)Device-related events (damage of device components, device malfunction, and device separation)
Gaudard et al [27]Observational, retrospective study40Impella 5.0Major device malfunction (device failure), minor device malfunction (flow, position or pressure monitoring failure), device malposition (intra-aortic or intra-left ventricular moving), and bleeding
Lemair et al [28]Observational, retrospective study47Impella 5 (80%); Impella 2.5 (20%)Device malfunction (due to kinking or unknown etiology) and high purge pressures
Meyns et al [29]Observational, retrospective study16Impella 2.5Device sensor failure and pump displacement
Lauten et al [30]Observational, retrospective study120Impella 2.5Device malfunction
Ranc et al [31]Case report1Impella 5.0Acute thrombosis of the Impella inflow portion
Succar et al [32]Case series5Impella CPImpella thrombosis treated with tissue plasminogen activator
Floyd et al [33]Case report1Impella CPKinking of catheter due to short stature
Alkhawam et al [34]Case report1Impella 5.0Right ventricular failure
Hotta et al [35]Case series3Impella 5.0New-onset aortic regurgitation after Impella placement

 

Table 2. Studies Evaluating the Effect of Atrioventricular Dyssynchrony on Impella Hemodynamics
 
StudyStudy typeNo. of patientsType(s) of ImpellaFactors
Sardana et al [41]Case report1Impella CPAtrioventricular dyssynchrony
Tahir et al [42]Case report1Impella CPAtrioventricular dyssynchrony managed successfully with atrioventricular sequential pacing resulting in improved hemodynamics and correction of recurrent ventricular fibrillation