Key result
Atrial-His bundle pacing supports LVEF recovery to 58% in a patient with severe fulminant myocarditis.
Why the study?
Fulminant myocarditis can cause threatening dysrhythmias requiring temporary pacing, and His bundle pacing maintains better cardiac synchronization than traditional right ventricular pacing.
Does temporary His bundle pacing improve hemodynamics and cardiac synchronization in a patient with fulminant myocarditis and ventricular arrhythmia?
Case Report (n=1)
No
Does temporary His bundle pacing improve hemodynamics and cardiac synchronization in a patient with fulminant myocarditis and ventricular arrhythmia?
Temporary His bundle pacing in DDD mode successfully provided physiological chronotropic support and improved hemodynamics in a patient with fulminant myocarditis and cardiogenic shock.
May support temporary His bundle pacing in fulminant myocarditis shock; hypothesis-generating case report leaves open prospective validation.
BACKGROUND: Fulminant myocarditis is a clinical syndrome associated with threatening dysrhythmia which temporary pacemaker can be used for life-saving support. As a method of physiological pacing, His bundle pacing (HBP) maintain better cardiac synchronization than traditional right ventricular (RV) pacing. CASE PRESENTATION: It's a severe case of fulminant myocarditis in a 41-year-old patient who presented for recurrent arrhythmias with hemodynamic instability. Temporary His bundle pacing combined with optimal medical therapy and extracorporeal membrane oxygenators (ECMO) supported him through his critical period of hospitalization. CONCLUSIONS: During 1-year follow up, the cardiac function recovery was obvious without any pacing related complications. Echocardiography showed better atrioventricular and intra-ventricular synchronization during HBP in DDD mode. This is the first reported case of temporary His-purkinje conduction system pacing used for severe fulminant myocarditis.
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Jiang et al. (2022) conducted a case report in Fulminant myocarditis with ventricular arrhythmia (n=1). Atrial-His bundle pacing (HBP) vs. Right ventricular septal pacing (RVSP) was evaluated on Cardiac function recovery and synchronization. Atrial-His bundle pacing in DDD mode successfully supported a patient with severe fulminant myocarditis, resulting in improved hemodynamics and left ventricular ejection fraction recovery to 58% at 1 year.
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