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Tolerance of Sustained Ventricular Fibrillation During Left Ventricular Assist Device Support With IMPELLA CP®

Rodolfo Caminiti1, Luigi Colarusso1, Giampiero Vizzari1

  • 1Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|December 10, 2021
PubMed

Insights

A patient with ST-segment elevation myocardial infarction experienced ventricular fibrillation despite mechanical circulatory support. A single DC shock successfully restored sinus rhythm, highlighting a critical intervention for life-threatening arrhythmias.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • Subacute anterior ST-segment elevation myocardial infarction (STEMI) can lead to significant left ventricular dysfunction.
  • Percutaneous coronary intervention (PCI) with drug-eluting stents is a primary treatment for STEMI.
  • Mechanical circulatory support (MCS) devices may be necessary to maintain systemic perfusion in severe left ventricular dysfunction.

Observation:

  • A 64-year-old man with STEMI developed worsening left ventricular ejection fraction post-PCI.
  • The patient required an Impella CP device for hemodynamic support.
  • Rapid ventricular tachycardia degenerating into ventricular fibrillation occurred 12 hours after MCS initiation.

Findings:

  • The patient remained conscious and alert during the ventricular arrhythmia, lasting 10 minutes.
  • A single unsynchronized 200 J direct current (DC) shock successfully converted the patient to sinus rhythm.
  • This case demonstrates successful defibrillation in a patient with severe LV dysfunction supported by MCS.

Implications:

  • Prompt recognition and management of life-threatening ventricular arrhythmias are crucial in post-MI patients with MCS.
  • The use of a single unsynchronized DC shock can be effective in terminating ventricular fibrillation in this high-risk population.
  • This case highlights the importance of advanced hemodynamic and electrical management in complex cardiac emergencies.

Keywords:
Impella CPLeft ventricular assistance deviceVentricular fibrillationVentricular tachycardia

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