Why the study?
To establish a basic understanding of cardiogenic shock management and reinforce the adverse effects associated with right ventricular pacing.
Does atrial pacing via dual-chamber ICD upgrade resolve cardiogenic shock caused by acute right ventricular pacing-induced ventricular dyssynchrony in a patient with HFrEF and sinus arrest?
Does atrial pacing via dual-chamber ICD upgrade resolve cardiogenic shock caused by acute right ventricular pacing-induced ventricular dyssynchrony in a patient with HFrEF and sinus arrest?
In patients with underlying LV systolic dysfunction and single-chamber ICDs, an acute increase in right ventricular pacing burden due to sinus arrest can precipitate cardiogenic shock via ventricular dyssynchrony, which can be rapidly reversed by restoring AV synchrony and intrinsic ventricular conduction through atrial pacing.
Answers are grounded in this paper and cite their sources.
May suggest atrial pacing trial in RV pacing shock; single case leaves open prospective validation.
We present a case of a man with ischemic cardiomyopathy and single chamber implantable cardioverter-defibrillator who developed sinus arrest creating sudden dependence on right ventricular (RV) pacing. He presented with cardiogenic shock secondary to abrupt onset ventricular dyssynchrony from RV pacing, which required emergent stabilization and completely resolved with atrial pacing. Learning objective: To establish a basic understanding of cardiogenic shock management. To reinforce the adverse effects associated with right ventricular pacing.
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Chakrala et al. (2024) studied this question.
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