PMID- 33722763 OWN - NLM STAT- MEDLINE DCOM- 20220210 LR - 20220210 IS - 1556-3871 (Electronic) IS - 1547-5271 (Linking) VI - 18 IP - 7 DP - 2021 Jul TI - Arrhythmia-induced cardiomyopathy: A potentially reversible cause of refractory cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation. PG - 1106-1112 LID - S1547-5271(21)00206-X [pii] LID - 10.1016/j.hrthm.2021.03.014 [doi] AB - BACKGROUND: The most severe form of arrhythmia-induced cardiomyopathy in adults- refractory cardiogenic shock requiring mechanical circulatory support-has rarely been reported. OBJECTIVE: The purpose of this study was to describe the management of critically ill patients admitted for acute, nonischemic, or worsening of previously known cardiac dysfunction and recent-onset supraventricular arrhythmia who developed refractory cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). METHODS: This study is a retrospective analysis of prospectively collected data. RESULTS: Between 2004 and 2018, 35 patients received VA-ECMO for acute, nonischemic cardiogenic shock and recent supraventricular arrhythmia (77% atrial fibrillation [AF]). Cardiogenic shock was the first disease manifestation in 21 patients (60%). Characteristics at ECMO implantation [median (interquartile range)] were Sequential Organ Failure Assessment score 10 (7-13); inotrope score 29 (11-80); left ventricular ejection (LVEF) fraction 10% (10%-15%); and lactate level 8 (4-11) mmol/L. For 12 patients, amiodarone and/or electric cardioversion successfully reduced arrhythmia, improved LVEF, and enabled weaning off VA-ECMO; 11 had long-term survival without transplantation or long-term assist device. Eight patients experiencing arrhythmia-reduction failure underwent ablation procedures (7 atrioventricular node [AVN] with pacing, 1 atrial tachycardia) and were weaned off VA-ECMO; 7 survived. Of the remaining 15 patients without arrhythmia reduction or ablation, only the 6 bridged to heart transplantation or left ventricular (LV) assist device survived. CONCLUSION: Arrhythmia-induced cardiomyopathy, mainly AF-related, is an underrecognized cause of refractory cardiogenic shock and should be considered in patients with nonischemic cardiogenic shock and recent-onset supraventricular arrhythmia. VA-ECMO support allowed safe arrhythmia reduction or rate control by AVN ablation while awaiting recovery, even among those with severe LV dilation. CI - Copyright (c) 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. FAU - Hekimian, Guillaume AU - Hekimian G AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. Electronic address: guillaume.hekimian@aphp.fr. FAU - Paulo, Nicolas AU - Paulo N AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Waintraub, Xavier AU - Waintraub X AD - Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France. FAU - Brechot, Nicolas AU - Brechot N AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Schmidt, Matthieu AU - Schmidt M AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Lebreton, Guillaume AU - Lebreton G AD - Department of Cardiac and Thoracic Surgery, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France. FAU - Pineton de Chambrun, Marc AU - Pineton de Chambrun M AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Muller, Gregoire AU - Muller G AD - Intensive Care Unit, Hopital d'Orleans, Orleans, France. FAU - Franchineau, Guillaume AU - Franchineau G AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Bourcier, Simon AU - Bourcier S AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Nieszkowska, Ania AU - Nieszkowska A AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Masi, Paul AU - Masi P AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Leprince, Pascal AU - Leprince P AD - Department of Cardiac and Thoracic Surgery, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France. FAU - Combes, Alain AU - Combes A AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Gandjbakhch, Estelle AU - Gandjbakhch E AD - Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France. FAU - Luyt, Charles-Edouard AU - Luyt CE AD - Service de Medecine Intensive Reanimation, Institute of Cardiology, Pierre et Marie Curie Sorbonne Universite, APHP, Groupe Hospitalier Pitie-Salpetriere, Paris, France; UPMC Universite Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France. LA - eng PT - Journal Article DEP - 20210312 PL - United States TA - Heart Rhythm JT - Heart rhythm JID - 101200317 SB - IM CIN - Heart Rhythm. 2021 Jul;18(7):1113-1114. PMID: 33737231 MH - Adult MH - Aged MH - Arrhythmias, Cardiac/*complications MH - Cardiomyopathies/*complications MH - Extracorporeal Membrane Oxygenation/*methods MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Shock, Cardiogenic/*etiology/therapy OTO - NOTNLM OT - Ablation OT - Arrhythmia OT - Atrial fibrillation OT - Cardiogenic shock OT - Extracorporeal membrane oxygenation EDAT- 2021/03/17 06:00 MHDA- 2022/02/11 06:00 CRDT- 2021/03/16 06:11 PHST- 2021/02/03 00:00 [received] PHST- 2021/03/04 00:00 [revised] PHST- 2021/03/08 00:00 [accepted] PHST- 2021/03/17 06:00 [pubmed] PHST- 2022/02/11 06:00 [medline] PHST- 2021/03/16 06:11 [entrez] AID - S1547-5271(21)00206-X [pii] AID - 10.1016/j.hrthm.2021.03.014 [doi] PST - ppublish SO - Heart Rhythm. 2021 Jul;18(7):1106-1112. doi: 10.1016/j.hrthm.2021.03.014. Epub 2021 Mar 12.