Tavazzi Guido, Dammassa Valentino, Colombo Costanza Natalia Julia, Arbustini Eloisa, Castelein Thomas, Balik Martin, Vandenbriele Christophe
Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
Department of Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Front Cardiovasc Med. 2022 Oct 11;9:987008. doi: 10.3389/fcvm.2022.987008. eCollection 2022.
In atrial and ventricular tachyarrhythmias, reduced time for ventricular filling and loss of atrial contribution lead to a significant reduction in cardiac output, resulting in cardiogenic shock. This may also occur during catheter ablation in 11% of overall procedures and is associated with increased mortality. Managing cardiogenic shock and (supra) ventricular arrhythmias is particularly challenging. Inotropic support may exacerbate tachyarrhythmias or accelerate heart rate; antiarrhythmic drugs often come with negative inotropic effects, and electrical reconversions may risk worsening circulatory failure or even cardiac arrest. The drop in native cardiac output during an arrhythmic storm can be partly covered by the insertion of percutaneous mechanical circulatory support (MCS) devices guaranteeing end-organ perfusion. This provides physicians a time window of stability to investigate the underlying cause of arrhythmia and allow proper therapeutic interventions (e.g., percutaneous coronary intervention and catheter ablation). Temporary MCS can be used in the case of overt hemodynamic decompensation or as a "preemptive strategy" to avoid circulatory instability during interventional cardiology procedures in high-risk patients. Despite the increasing use of MCS in cardiogenic shock and during catheter ablation procedures, the recommendation level is still low, considering the lack of large observational studies and randomized clinical trials. Therefore, the evidence on the timing and the kinds of MCS devices has also scarcely been investigated. In the current review, we discuss the available evidence in the literature and gaps in knowledge on the use of MCS devices in the setting of ventricular arrhythmias and arrhythmic storms, including a specific focus on pathophysiology and related therapies.
在房性和室性快速性心律失常中，心室充盈时间缩短以及心房作用丧失导致心输出量显著减少，进而引发心源性休克。在总体手术过程中，这一情况在11%的导管消融术中也可能发生，并且与死亡率增加相关。处理心源性休克和（室上性）室性心律失常极具挑战性。正性肌力支持可能会加重快速性心律失常或加快心率；抗心律失常药物通常伴有负性肌力作用，而电复律可能会使循环衰竭恶化甚至导致心脏骤停。心律失常风暴期间心脏自身输出量的下降可通过插入经皮机械循环支持（MCS）装置部分弥补，以保证终末器官灌注。这为医生提供了一个稳定的时间窗来探究心律失常的潜在原因并进行适当的治疗干预（如经皮冠状动脉介入治疗和导管消融）。临时MCS可用于明显的血流动力学失代偿情况，或作为一种“预防策略”，以避免高危患者在介入心脏病学手术期间出现循环不稳定。尽管MCS在治疗心源性休克和导管消融手术中的应用日益增加，但鉴于缺乏大型观察性研究和随机临床试验，其推荐级别仍然较低。因此，关于MCS装置的使用时机和种类的证据也几乎未得到研究。在本综述中，我们讨论了文献中关于在室性心律失常和心律失常风暴背景下使用MCS装置的现有证据以及知识空白，特别关注了病理生理学和相关治疗方法。
