Percutaneous Left Ventricular Assist Device Leads to Heart Rhythm Stabilisation in Cardiogenic Shock: Results from the Dresden Impella Registry
| Autor: | Stefanie Jellinghaus, Silvio Quick, Karim Ibrahim, Sabrina Jahn, Georg Ende, Uwe Speiser, Tobias Loehn, Johannes Mierke, Axel Linke, Christian Pfluecke |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Tachycardia medicine.medical_specialty Defibrillation medicine.medical_treatment Shock Cardiogenic 030204 cardiovascular system & hematology Ventricular Function Left 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Registries 030212 general & internal medicine Myocardial infarction Impella Retrospective Studies Ejection fraction business.industry Cardiogenic shock Stroke Volume medicine.disease Treatment Outcome medicine.anatomical_structure Ventricle Ventricular assist device Cardiology Heart-Assist Devices medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart, Lung and Circulation. 30:577-584 |
| ISSN: | 1443-9506 |
| DOI: | 10.1016/j.hlc.2020.08.005 |
| Popis: | Background Severe heart rhythm disturbances (SHRDs) occur regularly in cardiogenic shock (CS). Percutaneous left ventricular assist devices (pLVADs) can actively unload the left ventricle (LV), decreasing left ventricular end-diastolic pressure and wall tension, which are suspected parameters for the induction and maintenance of arrhythmias. The aim of this study was to describe effects of LV unloading on SHRD. Method In the Dresden Impella Registry, 97 patients received an Impella CP in refractory CS. Of them, 19 had SHRDs, which were not stopped by common therapeutic strategies such as electrical defibrillation or antiarrhythmic drugs. They were only stopped after implantation of a micro-axial heart pump. This phenomenon was referred to as heart rhythm stabilisation (HRS). Clinical outcome and laboratory parameters were assessed and risk factors for the occurrence of HRS were identified. Results All 19 patients with refractory SHRD terminated immediately into a stable heart rhythm after insertion of the micro-axial heart pump. In 37% no additional defibrillation was needed. Of the patients with HRS, CS was mostly caused by myocardial infarction (68%). Resuscitation before pLVAD was performed in 89% for more than 30 minutes. Patients with HRS were resuscitated more frequently and for a longer duration than patients without HRS. After HRS, the serum lactate and norepinephrine dosage decreased in the first 12 hours, whereas left ventricular ejection fraction increased by 95%. Conclusions Left ventricular unloading in patients with CS seems to be an option for treating patients with sustained life-threatening tachycardia, who are refractory to common treatment. |
| Databáze: | OpenAIRE |
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