Elmahrouk Ahmed F, Elghaysha Ehab, Arafat Amr A, Edrees Azzahra, Aluthman Uthman, Jamjoom Ahmed A
Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Cardiac Surgery Intensive Care Unit (CSICU) Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
J Card Surg. 2020 Feb;35(2):480-481. doi: 10.1111/jocs.14380. Epub 2019 Nov 25.
Ventricular fibrillation (VF) is a well-known ominous complication of ischemic heart disease. While firmly structured algorithms have been developed for its management, yet its mortality rate remains high.
This is a case report of a 46-year-old gentleman who was a victim of recurrent cardiac arrest in the ward while awaiting coronary artery bypass grafting (CABG) surgery. Emergency CABG was performed, intraoperatively he experienced recurrent VF which was reverted by direct current cardioversion-Defibrillation. He was sent to the Cardiac Surgery Intensive Care Unit (CSICU) with an open chest on extracorporeal membrane oxygenation (ECMO) support and an intra-aortic balloon pump. Postoperatively in CSICU he still experienced malignant ventricular arrhythmia with dropping of ejection fraction to less than 10%. The last few episodes of VF were lengthy, lasting more than an hour (while on ECMO support) with the failure of various antiarrhythmic medications to abort them. Eventually, a decision was made to give him 20 mmol boluses of potassium chloride (KCl) intravenously aiming at introducing a state of asystole, but the rhythm changed to sinus rhythm.
This report highlighted the fact that optimum management of VF is still lacking and necessitates more studies. The appropriate effective dose of potassium replacement during VF might need to be reconsidered in patients with persistent VF.
心室颤动（VF）是缺血性心脏病一种广为人知的严重并发症。虽然已制定了严格的管理算法，但死亡率仍然很高。
这是一例46岁男性的病例报告，该患者在等待冠状动脉搭桥术（CABG）手术期间在病房发生反复心脏骤停。进行了急诊CABG，术中他经历了反复的VF，通过直流电复律除颤得以恢复。他在体外膜肺氧合（ECMO）支持和主动脉内球囊泵辅助下开胸被送往心脏外科重症监护病房（CSICU）。术后在CSICU，他仍经历恶性室性心律失常，射血分数降至10%以下。最后几次VF发作持续时间较长，超过一小时（在ECMO支持期间），各种抗心律失常药物均未能终止发作。最终，决定给他静脉注射20 mmol氯化钾推注，旨在诱导心脏停搏状态，但心律转变为窦性心律。
本报告强调了仍然缺乏VF最佳管理方法这一事实，需要更多研究。对于持续性VF患者，可能需要重新考虑VF期间补钾的合适有效剂量。
