Document Detail


Temporary left ventricular stimulation in patients with refractory cardiogenic shock and asynchronous left ventricular contraction:a safety and feasibility study.
MedLine Citation:
PMID:  22982965     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Despite modern treatment strategies cardiogenic shock (CS) is still associated with high mortality. OBJECTIVE: This study sought to evaluate the feasibility and safety of temporary percutaneous left ventricular (LV) stimulation as rescue therapy in patients with CS refractory to standard clinical care. METHODS: Consecutive patients with deteriorating CS without further treatment options received transjugular placement of a temporary LV lead if they exhibited signs of asynchronous LV contraction. To maintain atrioventricular synchronous contraction an additional right atrial lead was placed in patients with sinus rhythm. The leads were externally connected to a conventional pacemaker. Hemodynamic course, clinical outcome and adverse events were assessed. RESULTS: A total of 15 patients [ischemic cardiomyopathy (n=8), dilated cardiomyopathy (n=6), acute myocarditis (n=1)] underwent successful lead placement. Median procedure and fluoroscopy times measured 60min (interquartile range 55;90) and 12min (IQR 7;34), respectively. Ten patients (67%) acutely responded by improvement of hemodynamic parameters with simultaneous reduction of catecholamine support. Catecholamine therapy was discontinued after a median of 28hours (IQR 16;60). The temporary leads were removed after a median of 6 days (IQR 3;10). Total in-hospital mortality was 47%, measuring 80% in non-responders and 30% in responders (p=0.119). There was no therapy related serious adverse event. CONCLUSION: Our data indicate that there may be a role for temporary LV stimulation as rescue therapy in selected patients with refractory cardiogenic shock. In clinical situations where aggressive therapies are used for urgent hemodynamic stabilization, temporary LV stimulation may evolve as a further and less invasive treatment option.
Authors:
Charlotte Eitel; Thomas Gaspar; Kerstin Bode; Bruno Andrea; Philipp Sommer; Carsten Stoepel; Thomas Sarwas; Eigk Grebe; Holger Thiele; Gerhard Hindricks; Christopher Piorkowski
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-13
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
University of Leipzig, Heart Center, Dept. of Electrophysiology, Leipzig, Germany.
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