Extracorporeal life support to terminate refractory ventricular tachycardia

Abstract

Extracorporeal life support (ECLS) has been applied successfully to patients with cardiopulmonary failure in extreme situations. Refractory ventricular tachycardia has high mortality and morbidity rates if not terminated in time. This study describes our preliminary experiences in using ECLS to treat patients with refractory ventricular tachycardia. Retrospective chart review. Hospital. Eleven patients suffering from ventricular tachycardia refractory to antiarrhythmia agents and cardioversion attempts. From January 2002 to December 2004, 11 patients suffering from ventricular tachycardia refractory to antiarrhythmia agents and cardioversion attempts were treated with ECLS. Mean patient age was 31 +/- 21 yrs (range, 3-69 yrs). The triggering events were acute myocarditis (n = 8), coronary artery spasm (n = 1), and hypoxemia secondary to acute respiratory distress syndrome (n = 2). Nine (82%) patients received venoarterial mode support and the remaining two (18%) were supported with venovenous mode to correct hypoxemia. Pump flow was first maximized (mean, 3800 +/- 1100 mL/min) to unload the heart, and an intra-aortic balloon pump was used to deal with the increased afterload (n = 8). Mean ventricular tachycardia duration before ECLS was 50 +/- 16 mins (range, 20-75 mins) and soon converted to a sinus rhythm following ECLS deployment, including four patients who experienced spontaneous recovery without attempted cardioversion, in a mean of 7.4 mins (range, 1-20 mins). Four patients required temporary pacing but none needed a permanent pacemaker after recovery. Mean duration of ECLS support was 119 +/- 69 hrs (range, 12-250 hrs). We excluded one patient who had permanent brain injury and another who succumbed to multiple organ failure. Nine (82%) patients were weaned and discharged with normal cardiac function. No recurrent ventricular tachycardia attack but one recurrent cardiomyopathy (ejection fraction = 15%) was reported during a mean 42-month follow-up. Using ECLS to terminate refractory ventricular tachycardia proved effective for selected patients when conventional therapeutic options were exhausted. Early deployment of ECLS to prevent secondary organ injury, maintain sufficient cardiac unloading, and avoid complications during ECLS support was central to successful outcomes.