Associazione Nazionale Medici Cardiologi Ospedalieri



Cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) during catheter ablation of ventricular fibrillation: a case report

Perniciaro Vera Acquaviva delle Fonti(BA) – Ente Ecclesiastico Ospedale Generale Regionale “F. Miulli” | Troisi Federica Acquaviva delle Fonti(BA) – Ente Ecclesiastico Ospedale Generale Regionale “F. Miulli” | Katsouras Grigorios Acquaviva delle Fonti(Bari) – Ente Ecclesiastico Ospedale Generale Regionale “F. Miulli”

The clinical case deals with a 46-year-old man, severely obese and suffering from type II diabetes mellitus and arterial hypertension, a smoker. He was admitted to our department for iterative ventricular fibrillation (VF) following a recent acute myocardial infarction with ST-segment elevation treated with percutaneous coronary angioplasty (PTCA) and implantation of drug-eluting stents on the anterior interventricular. Control coronary angiography showed good results of previous PTCA. On the echocardiogram, left ventricular pump function moderately reduced (EF 45%) with district alterations of the kinetics and aneurysmal dilatation of the ascending aorta. During hospitalization, iterative episodes of VF despite maximal antiarrhythmic therapy, promptly treated with DC shock. Continuous telemetry monitoring showed frequent early premature ventricular complex (PVC) triggering VF episodes. A 12-lead Holter ECG was performed to better identify the morphology of these PVC, documenting PVC of morphology compatible with origin from Purkinjie fibres. An electrophysiological study and mapping of the left ventricle were performed with extracorporeal membrane oxygenation (ECMO) support. During mapping of the middle left interventricular septum, VF occurred several times and was promptly treated with DC shock. In this area have been documented Purkinje fibers and low voltage and multifragmented areas; ablation was then performed by delivering radiofrequency in this area until the all potentials were completely eliminated. After ablation, no more ventricular arrhythmias were induced. Cardiac magnetic resonance imaging was performed which showed large areas of late gadolinium enhancement. The patient underwent automatic defibrillator implantation. Ventricular arrhythmias were no longer documented during telemetric monitoring.

In this complex case of significant arrhythmic instability in ischemic heart disease with moderate left ventricular pump dysfunction, ECMO assistance allowed us to effectively and safely perform the ablation of the arrhythmic substrate triggering the iterative episodes of VF.