Ventricular Tachycardia Storm in a HeartMate III LVAD Recipient Complicated by Subglottic Stenosis: A Case Report

Abstract

Durable left ventricular assist devices (LVADs) are widely used as destination therapy and bridge-to-transplantation for advanced heart failure. Despite improved survival, complications such as ventricular arrhythmias remain common, occurring in up to 35% of patients. We report the case of a 60-year-old woman with a HeartMate III LVAD who presented with a ventricular tachycardia (VT) storm accompanied by hypotension, dyspnea, and fluctuating oxygen saturation. Initial evaluation revealed monomorphic VT, pulmonary congestion, and grade I subglottic stenosis contributing to respiratory distress. Management included urgent synchronized cardioversion, intravenous amiodarone infusion, corticosteroid therapy for airway edema, and cautious restriction of intravenous fluids. These interventions successfully restored sinus rhythm and improved airway stability. The patient transitioned to oral amiodarone, remained hemodynamically stable, and was discharged on day six. At 30-day follow-up, she exhibited no recurrent arrhythmia and maintained stable LVAD function. This case highlights the need for rapid, multidisciplinary intervention in LVAD-supported patients presenting with VT storm, especially when complicated by concurrent airway pathology.