Indian Journal of Critical Care Case Report

Register      Login

VOLUME 2 , ISSUE 3 ( May-June, 2023 ) > List of Articles

CASE REPORT

A Rare Case Report: VA ECMO Support for Cardiogenic Shock Caused by Arrhythmia-induced Cardiomyopathy

Sanjay K Nihalani, Apoorva B Singhal, Gerasmos Capatos, Kalpana Krishnareddy, Seemin Shiraz, Anil Agarwal

Keywords : Atrial fibrillation, Cardiomyopathy, Extracorporeal membrane oxygenation

Citation Information : Nihalani SK, Singhal AB, Capatos G, Krishnareddy K, Shiraz S, Agarwal A. A Rare Case Report: VA ECMO Support for Cardiogenic Shock Caused by Arrhythmia-induced Cardiomyopathy. 2023; 2 (3):82-84.

DOI: 10.5005/jp-journals-11006-0059

License: CC BY-NC 4.0

Published Online: 26-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Herein we report a rare case of venoarterial extracorporeal membrane oxygenation (VA ECMO) support in a patient with arrhythmia-induced cardiomyopathy and cardiogenic shock. The patient had a lactate of more than 20 at the time of initiation of ECMO. Arrhythmia-induced cardiomyopathy is a potentially reversible state in which atrial or ventricular tachycardia/arrhythmias results in a decrease in left ventricular (LV) function, causing systolic heart failure and in rare cases, cardiogenic shock.1 VA ECMO is now increasingly used for various forms of cardiogenic shock, including the above condition that is unresponsive to conventional therapy. This is a case report of middle age man who presented with atrial fibrillation (AF) and rate related cardiomyopathy resulting in severe cardiogenic shock. He failed to respond to conventional management, including rate control medications, inotropic, and vasopressor agents. He had a cardiac arrest and was revived postcardiopulmonary resuscitation. Only with the early initiation of VA ECMO could the stabilization of hemodynamics be maintained. Further, ECMO support gave us the time for the reversible cardiomyopathy to resolve, and the patient survived who otherwise may not have in view of poor ejection fraction (EF) of 10%.


HTML PDF Share
  1. Gopinathannair R, Etheridge SP, Marchlinski FE, et al. Arrhythmia-induced cardiomyopathies: mechanisms, recognition, and management. J Am Coll Cardiol 2015;66(15):1714–1728. DOI: 10.1016/j.jacc.2015.08.038
  2. Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol 2003;91(6A):2D–8D. DOI: 10.1016/s0002-9149(02)03373-8
  3. Papadakis M. Atrial fibrillation. current medical diagnosis and treatment. 2018; 57th ed., PP. 394–395. Mc Graw Hill education, New York.
  4. Hékimian G, Paulo N, Waintraub X, et al. Arrhythmia-induced cardiomyopathy: a potentially reversible cause of refractory cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation. Heart Rhythm 2021;18(7):1106–1112. DOI: 10.1016/j.hrthm.2021.03.014
  5. Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: adult advanced cardiovascular life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132(18 Suppl 2):S444–S464. DOI: 10.1161/CIR.0000000000000261
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.