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Intracardiac atrial overdrive pacing as an alternative to extracorporeal membrane oxygenation in the treatment of cardiogenic shock due to drug refractory and incessant persistent junctional reciprocating tachycardia in a 7-month-old infant


Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland

Correspondence Address:
Prof. Bozena Werner
Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 63A Zwirki I Wigury Street, 02-091 Warsaw
Poland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_186_19

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Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 231-234

 

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In the case of prolonged, undiagnosed persistent junctional reciprocating tachycardia in infants, compensatory mechanisms are exhausted leading to heart failure. However, when cardioverted to sinus rhythm patients often deteriorate due to cardiac output dependency on the higher rates. Extracorporeal mechanical oxygenation (ECMO) is often used to stabilize their hemodynamic status. An 7-month-old female infant was admitted in cardiogenic shock due to drug refractory supraventricular tachycardia (SVT). Pharmacological cardioversion to sinus rhythm with heart rate (HR) of 90 bpm was achieved but resulted in hemodynamic deterioration and early recurrence of arrhythmia. Right atrial overdrive pacing (ODP) wire was introduced through femoral vein and allowed to override the tachycardia with 2:1 A:V block and HR of 160 bpm. ODP was continued for 24 h allowing to wean off the inotropic support. We postulate that ODP can be a safe and less invasive alternative to ECMO in stabilizing infants with cardiogenic shock due to intractable SVTs.






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Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland

Correspondence Address:
Prof. Bozena Werner
Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 63A Zwirki I Wigury Street, 02-091 Warsaw
Poland
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_186_19

Rights and Permissions

In the case of prolonged, undiagnosed persistent junctional reciprocating tachycardia in infants, compensatory mechanisms are exhausted leading to heart failure. However, when cardioverted to sinus rhythm patients often deteriorate due to cardiac output dependency on the higher rates. Extracorporeal mechanical oxygenation (ECMO) is often used to stabilize their hemodynamic status. An 7-month-old female infant was admitted in cardiogenic shock due to drug refractory supraventricular tachycardia (SVT). Pharmacological cardioversion to sinus rhythm with heart rate (HR) of 90 bpm was achieved but resulted in hemodynamic deterioration and early recurrence of arrhythmia. Right atrial overdrive pacing (ODP) wire was introduced through femoral vein and allowed to override the tachycardia with 2:1 A:V block and HR of 160 bpm. ODP was continued for 24 h allowing to wean off the inotropic support. We postulate that ODP can be a safe and less invasive alternative to ECMO in stabilizing infants with cardiogenic shock due to intractable SVTs.






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