Abstract 5925: Temporary Percutaneus Left Ventricular Stimulation in Patients with Cardiogenic Shock and Asynchronous Left Ventricular Contraction
Despite modern medical treatment strategies such as early coronary revascularization and intraaortic balloon pump cardiogenic shock is still associated with a high mortality. Cardiac resynchronization therapy (CRT) has shown significant benefits in patients with symptomatic heart failure and asynchronous left ventricular contraction. In the present study CRT was used as a temporary treatment strategy in patients with cardiogenic shock without further treatment options. 11 consecutive patients with cardiogenic shock (6 ICM, 5 DCM) and asynchronous left ventricular contraction (Δ PEP, SPWMD) received a temporary left ventricular (LV) lead, introduced through the right jugular vein and positioned in a posterolateral target vein. 4 patients were pacemaker dependent due to AV-block III, 7 patients were in SR with intrinsic AV conduction and additionally received a temporary right atrial lead for AV synchronous LV stimulation. The leads were externally connected to a re-sterilized single or dual chamber pacemaker. In all 11 patients the external LV lead could be positioned in a posterolateral target vein. Median procedure time was 24 (15;90) min. Median radiation time was 12 (8,25) min. After LV lead placement mean arterial pressure significantly improved in median by 15 (5,30) mmHg. After two days of therapy 8/11 (73%) patients were free from catecholamines. Median duration of temporary LV stimulation was 5 (2,12) days. The 30 day mortality measured 4/11 (36%). 6/7 surviving patients received permanent implantation of a CRT device subsequently. A temporary percutaneus left ventricular stimulation in patients with cardiogenic shock is feasible. In selected patients with terminal cardiogenic shock and lack of further treatment options temporary left ventricular stimulation can significantly improve the patient’s hemodynamic situation.