Extracorporeal life support for refractory ventricular tachycardia

Abstract

Extracorporeal life support (ECLS) is a very effective bridging therapy in patients with refractory ventricular tachycardia (VT) associated with cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular arrhythmias, cardiac arrest, cardiogenic shock and/or pulmonary failure until further management options are explored. Data base searches were done using key words such as ECLS, VT, cardiac arrest, VT ablation, venoarterial extra-corporeal membrane oxygenation (VA-ECMO). The use of ECLS has been described in a few case reports to facilitate VT ablation for incessant VT refractory to medical therapy. For patients with, out-of- hospital ventricular fibrillation (VF) and VT, Minnesota Resuscitation Consortium has implemented emergent advanced perfusion and reperfusion strategy, followed by coronary angiography and primary coronary intervention to improve outcome. The major indications for ECLS are cardiogenic shock related to acute myocardial infarction, myocarditis, post embolic acute cor pulmonale, drug intoxication and post cardiac arrest syndrome with the threat of multi-organ failure. ECLS permits the use of negative inotropic antiarrhythmic drug therapy, facilitates the weaning of catecholamine administration, thereby ending the vicious cycle of catecholamine driven electric storm. ECLS provides hemodynamic support during ablation procedure, while mapping and induction of VT is undertaken. ECLS provides early access to cardiac catheterization laboratory in patients with cardiac arrest due to shockable rhythm. The current evidence from literature, supports the use of ECLS to ensure adequate vital organ perfusion in patients with refractory VT. ECLS is a safe, feasible and effective therapeutic option when conventional therapies are insufficient to support cardiopulmonary function. A highly driven multidisciplinary team approach is essential to accomplish this task.

Hemoadsorption in cardiac shock with bi ventricular failure and giant-cell myocarditis: A case report

“…4 Extracorporeal life support (ECLS) has become increasingly popular as a salvage strategy and bridging therapy not only in cardiac and lung failure patients but also in those with ventricular tachycardia associated with cardiogenic shock or cardiac arrest such as in giant-cell myocarditis. 5 ECLS is applied as a support for a severely impaired cardiac function (with or without lung failure) and thus ensures further supply of the body with oxygen. However, cardiac shock states necessitating ECLS support often result in the development of an overshooting, systemic inflammatory response syndrome (SIRS).…”

Novel approaches for the treatment of ventricular tachycardia

“…Extracorporeal life support is a highly efficient bridging treatment in patients with refractory VT associated with cardiogenic shock[ 37 ]. Extracorporeal life support allows the usage of negative inotropic antiarrhythmic drug therapy, leads to the weaning of catecholamine delivery, thus resolving the dangerous period of the catecholamine driven electrical storm[ 37 ].…”

“…Extracorporeal life support is a highly efficient bridging treatment in patients with refractory VT associated with cardiogenic shock[ 37 ]. Extracorporeal life support allows the usage of negative inotropic antiarrhythmic drug therapy, leads to the weaning of catecholamine delivery, thus resolving the dangerous period of the catecholamine driven electrical storm[ 37 ]. The utilization of extracorporeal life support maintains hemodynamic support during an ablation procedure, while mapping and induction of VT are commenced and provides sufficient vital organ perfusion in patients with refractory VT[ 37 ].…”

“…Extracorporeal life support allows the usage of negative inotropic antiarrhythmic drug therapy, leads to the weaning of catecholamine delivery, thus resolving the dangerous period of the catecholamine driven electrical storm[ 37 ]. The utilization of extracorporeal life support maintains hemodynamic support during an ablation procedure, while mapping and induction of VT are commenced and provides sufficient vital organ perfusion in patients with refractory VT[ 37 ]. Current literature suggests the usage of extracorporeal life support, as it has proven to be a safe, practical and efficient therapeutic solution when traditional treatments have failed[ 37 ].…”

“…The utilization of extracorporeal life support maintains hemodynamic support during an ablation procedure, while mapping and induction of VT are commenced and provides sufficient vital organ perfusion in patients with refractory VT[ 37 ]. Current literature suggests the usage of extracorporeal life support, as it has proven to be a safe, practical and efficient therapeutic solution when traditional treatments have failed[ 37 ].…”