Treating Incessant Tachyarrhythmia-Induced Cardiogenic Shock With Emergent Atrioventricular Node Ablation

Tachycardia-induced cardiogenic shock (TICS) is a life-threatening condition requiring prompt intervention. An elderly patient with chronic atrial fibrillation and multiple comorbidities developed refractory cardiogenic shock secondary to rapid ventricular rate. Initial management with antiarrhythmics, electrical cardioversion, and vasopressors failed to restore hemodynamic stability. Emergent atrioventricular node ablation (AVNA) with temporary biventricular pacemaker implantation was performed, resulting in immediate heart rate control and subsequent hemodynamic stabilization and heart failure recovery. This case highlights a rare mechanism of cardiogenic shock predominantly driven by diastolic dysfunction secondary to rapid atrial fibrillation. It also demonstrates the potential of emergent AVNA to serve as a life-saving strategy in critically ill patients with refractory TICS. Emergent AVNA can be a life-saving intervention for critically ill patients experiencing refractory TICS.