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Optimizing mechanical circulatory support hemodynamics using coronary sinus pacing.

Hassan Tahir1, Robert Tonks1, James Cox1

  • 1Department of Cardiology, University of Tennessee Medical Center, Heart Lung Vascular Institute, Knoxville, TN.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 5, 2021
PubMed
Summary
This summary is machine-generated.

Atrioventricular (AV) dyssynchrony can cause low Impella output in cardiogenic shock. Restoring AV synchrony rapidly stabilized hemodynamics in a unique acute anterior myocardial infarction case.

Keywords:
AV dyssynchronyAV sequential pacingImpellaSTEMIcardiogenic shockcoronary artery disease

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Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Medical Device Technology

Background:

  • Cardiogenic shock from acute anterior myocardial infarction (MI) often requires mechanical circulatory support.
  • Low Impella device output can complicate cardiogenic shock management.

Observation:

  • A patient with acute anterior MI and cardiogenic shock experienced recurrent hypotension and ventricular fibrillation.
  • These events were associated with atrioventricular (AV) dyssynchrony and low Impella output.

Findings:

  • Restoring AV synchrony via coronary sinus pacing immediately improved hemodynamic stability and Impella output.
  • This is the first reported case linking AV dyssynchrony to low Impella output in this clinical context.

Implications:

  • AV dyssynchrony should be considered as a cause of Impella device failure in cardiogenic shock.
  • Coronary sinus pacing may be a novel strategy to manage AV dyssynchrony and improve outcomes in these patients.