Abstract
A 59-year-old patient with dilated cardiomyopathy and incessant ventricular tachycardia leading to progressive cardiogenic shock is presented. Due to hemodynamic instability, high dose catecholamines were required in addition to the implantation of an intraaortic balloon pump (IABP), which, however, appeared to further augment the frequency and duration of ventricular tachycardias. The implantation of a microaxial blood pump allowed catecholamine administration to be terminated, thereby, ending this vicious circle of catecholamine-driven electrical storm. Within 5 days, the patient was hemodynamically stabilized and kidney and liver function recovered with the support of intensive antiarrhythmic therapy (amiodarone, mexiletine, sotalol). During a 24-month follow-up, the patient had no further ICD shocks and no rehospitalization was required for treatment of congestive heart failure.
Zusammenfassung
Wir berichten über den Fall eines 59-jährigen Patienten, der auf dem Boden einer dilatativen Kardiomyopathie im elektrischen Sturm zunehmend in einen kardiogenen Schock geriet. Aufgrund der hämodynamischen Instabilität war eine hochdosierte Katecholamingabe notwendig sowie die Implantation einer intraaortalen Ballonpumpe (IABP). Unter dieser Therapie kam es jedoch zu einer Zunahme der Häufigkeit sowie der Dauer der ventrikulären Tachykardien. Erst die Implantation einer mikroaxialen Blutpumpe ermöglichte es uns, die Katecholamine auszuschleichen und damit den durch diese aufrechterhaltenen Teufelskreis zu durchbrechen. Innerhalb von 5 Tagen war der Patient unter zusätzlichem Einsatz einer intensiven antiarrhythmischen Therapie (Amiodarone, Mexiletin, Sotalol) hämodynamisch stabil; Leber- und Nierenfunktion erholten sich. Über ein Follow-up von 24 Monaten traten keine weiteren ICD-Schockabgaben auf, und es war keine weitere Hospitalisierung auf dem Boden der Herzinsuffizienz notwendig.
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Henning, A., Schreieck, J., Riessen, R. et al. Successful bridge to recovery using a microaxial blood pump in a patient with electrical storm and cardiogenic shock. Intensivmed 48, 543–547 (2011). https://doi.org/10.1007/s00390-011-0289-3
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DOI: https://doi.org/10.1007/s00390-011-0289-3