Microaxial Flow Pump and Ivabradine for Tachycardia-Induced Cardiogenic Shock Caused by Automatic Atrial Tachycardia.

BACKGROUND

Management of tachycardia-induced cardiomyopathy (TIC) complicated by cardiogenic shock is challenging because rate control and hemodynamic stabilization must be achieved simultaneously.

CASE SUMMARY: A 32-year-old woman was transferred because of refractory narrow QRS tachycardia at a rate of 140 beats/min and cardiogenic shock with a left ventricular ejection fraction of 10% to 15%. P-wave morphology, failure to terminate with cardioversion, and a warm-up pattern suggested automatic atrial tachycardia originating near the sinus node. Severe left ventricular dysfunction was considered TIC. Under percutaneous microaxial flow pump support, ivabradine and landiolol achieved rate control without hemodynamic deterioration. Left ventricular function improved, allowing microaxial flow pump weaning and transition to oral bisoprolol.

DISCUSSION: Microaxial flow pump-supported pharmacological rate control may be a useful bridge-to-recovery strategy for this condition.

TAKE-HOME MESSAGES: A microaxial flow pump may provide hemodynamic support, facilitating safe rate control and myocardial recovery in TIC complicated by cardiogenic shock. Ivabradine may be useful when beta-blockers are difficult to initiate.