Recovery from fatal ventricular fibrillation after immediate application of percutaneous cardiopulmonary support
Matsunari, Y.; Imanaka, H.; Takeuchi, M.; Tachibana, K.; Takauchi, Y.
Masui. Japanese Journal of Anesthesiology 53(7): 795-798
2004
ISSN/ISBN: 0021-4892 PMID: 15298250 Document Number: 569937
We present a patient who recovered from refractory ventricular fibrillation after immediate application of percutaneous cardiopulmonary support (PCPS). On the postoperative day (POD) 3 after the Y-grafting surgery for abdominal aortic aneu- rysm, circulation collapsed due to sudden onset of ventricular fibrillation. Because ventricular fibrillation had persisted in spite of medical treatment and defibrillation, we established PCPS and his circulation recovered. Although an emergent coronary angiography revealed no new lesions, we performed an emergent percutaneous catheter intervention to deny the possibility that ischemic changes had contributed to the arrhythmia. Soon after percutaneous transluminal coronary angioplasty, we successfully weaned him from PCPS, and extubated his trachea on the POD 5 without any neurological deficits. On the POD 8, ventricular fibrillation occurred again and defibrillation was effective at this time. We suspected cardiac ischemia, prolonged QT interval, and electrical remodeling due to hypertrophic heart as possible causes of refractory ventricular fibrillation. Therefore, we performed percutaneous transluminal coronary angioplasty, terminated famotidine administration, maintained normal electrolytes level, started administration of beta-blocker, and implanted an cardioverter defibrillator. On the POD 16, he was discharged from the ICU with no neurological deficits.