Temporary left ventricular stimulation in patients with refractory cardiogenic shock and asynchronous left ventricular contraction: A safety and feasibility study

Abstract

Despite modern treatment strategies, cardiogenic shock (CS) is still associated with high mortality. To evaluate the feasibility and safety of temporary percutaneous left ventricular (LV) stimulation as rescue therapy in patients with CS refractory to standard clinical care. Consecutive patients with deteriorating CS without further treatment options received transjugular placement of a temporary LV lead if they exhibited signs of asynchronous LV contraction. To maintain atrioventricular synchronous contraction, an additional right atrial lead was placed in patients with sinus rhythm. The leads were externally connected to a conventional pacemaker. Hemodynamic course, clinical outcome, and adverse events were assessed. A total of 15 patients [ischemic cardiomyopathy (n = 8), dilated cardiomyopathy (n = 6), and acute myocarditis (n = 1)] underwent successful lead placement. Median procedure and fluoroscopy times measured 60 minutes (interquartile range [IQR] 55-90) and 12 minutes (IQR 7-34), respectively. Ten patients (67%) acutely responded by improvement of hemodynamic parameters with simultaneous reduction of catecholamine support. Catecholamine therapy was discontinued after a median of 28 hours (IQR 16-60). The temporary leads were removed after a median of 6 days (IQR 3-10). Total in-hospital mortality was 47%, measuring 80% in nonresponders and 30% in responders (P = .119). There was no therapy-related serious adverse event. Our data indicate that there may be a role for temporary LV stimulation as rescue therapy in selected patients with refractory CS. In clinical situations where aggressive therapies are used for urgent hemodynamic stabilization, temporary LV stimulation may evolve as a further and less invasive treatment option.