Loyalka Pranav, Hariharan Ramesh, Gholkar Gunjan, Gregoric Igor D, Tamerisa Ravi, Nathan Sriram, Kar Biswajit
Department of Cardiology, The Texas Heart Institute at St. Luke's Episcopal Hospital, TX 77030, USA.
Tex Heart Inst J. 2011;38(4):409-11.
A 58-year-old man presented with chest pain and tightness and was diagnosed with a Q-wave anterior myocardial infarction. He then developed pulseless ventricular arrhythmias, which were treated with repeated direct-current shocks and intravenous amiodarone. He underwent emergency cardiac catheterization: stents were deployed in the left anterior descending coronary artery and right coronary artery, and an intra-aortic balloon pump was inserted. Severe refractory cardiogenic shock and incessant ventricular arrhythmias compelled us to place a TandemHeart percutaneous left ventricular assist device 4 hours later. The patient's hemodynamic status stabilized, but the arrhythmias persisted for 36 hours. Multiple doses of intravenous amiodarone and lidocaine and multiple external direct-current shocks were all tried, but these measures failed to terminate the life-threatening ventricular arrhythmias. We performed a pharmacologic block of the left stellate ganglion, and this resulted in a return to sinus rhythm after 1 direct-current shock. To our knowledge, this is the 1st patient with refractory ventricular arrhythmias to have been treated with TandemHeart support and left stellate ganglion block.
一名58岁男性因胸痛和胸闷就诊，被诊断为Q波前壁心肌梗死。随后他出现无脉性室性心律失常，接受了多次直流电除颤和静脉注射胺碘酮治疗。他接受了急诊心脏导管插入术：在左前降支冠状动脉和右冠状动脉置入支架，并插入主动脉内球囊泵。严重的难治性心源性休克和持续性室性心律失常迫使我们在4小时后放置了一台TandemHeart经皮左心室辅助装置。患者的血流动力学状态稳定，但心律失常持续了36小时。尝试了多次静脉注射胺碘酮和利多卡因以及多次体外直流电除颤，但这些措施均未能终止危及生命的室性心律失常。我们对左侧星状神经节进行了药物阻滞，在1次直流电除颤后恢复为窦性心律。据我们所知，这是首例接受TandemHeart支持和左侧星状神经节阻滞治疗的难治性室性心律失常患者。
