Korean Circ J.  2017 Jan;47(1):132-135. 10.4070/kcj.2016.0176.

Cardiac Resynchronization Therapy Device Implantation in a Patient with Cardiogenic Shock under Percutaneous Mechanical Circulatory Support

• Lim K
• Choi JO
• Yang JH
• Park SJ
• Kim SH
• Kang J
• Joh HS
• Shin SH

• KMID: 2365292
• DOI: http://doi.org/10.4070/kcj.2016.0176

Abstract

65-year-old woman was admitted to our hospital with acute decompensated heart failure with reduced left ventricular ejection fraction and severe mitral regurgitation. Electrocardiography revealed a typical left bundle branch block and atrial fibrillation. Her condition deteriorated despite administering high-doses of inotropes and vasopressors. Pending a decision to therapy, venoarterial extracorporeal membrane oxygenation (ECMO) was performed when the patient underwent a cardiogenic shock. Although the hemodynamic status stabilized with ECMO support, weaning the patient from ECMO was not possible. Thus, we decided to perform cardiac resynchronization with defibrillator implantation as a "rescue" therapy. Five days post-implantation, the patient was successfully weaned from ECMO.

Keyword

Cardiac resynchronization therapy; Extracorporeal membrane oxygenation; Shock, cardiogenic

MeSH Terms

Aged
Atrial Fibrillation
Bundle-Branch Block
Cardiac Resynchronization Therapy*
Defibrillators
Electrocardiography
Extracorporeal Membrane Oxygenation
Female
Heart Failure
Hemodynamics
Humans
Mitral Valve Insufficiency
Shock, Cardiogenic*
Stroke Volume
Weaning

Figure

• 

  Fig. 1 Comparison of serial echocardiography images in end systolic phase. (A) Apical four-chamber view and parasternal long axis view of transthoracic echocardiography, showing severe left ventricular systolic dysfunction, all-chamber dilatation, and dyssynchronous cardiac motion. (B) Apical four-chamber view and parasternal long axis view of transthoracic echocardiography showing improved LV systolic function and LV dilatation dramatically with cardiac resynchronization therapy with defibrillator. LV: left ventricular.

• 

  Fig. 2 Two 12-lead electrocardiogram ECG taken before and after procedure. (A) ECG taken for the first time. It revealed atrial fibrillation, complete left-bundle branch block, and QRS duration of 141 msec. (B) 12-lead electrocardiogram taken after the procedure. The ECG shows every QRS complex is paced by the device. The QRS duration decreased to 132 msec. ECG: electrocardiogram.

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  Fig. 3 Chest radiography images performed before and after CRT-D implantation. (A) Before CRT-D implantation: cardiomegaly and pulmonary edema are seen even during extracorporeal membrane oxygenation support. (B) Postoperative chest radiography showing the CRT-D device: left ventricular endocardial pacing leads are inserted (black arrow). CRT-D: cardiac resynchronization therapy with defibrillator.

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