TY - JOUR
T1 - Successful treatment of tachycardia-induced cardiomyopathy with LVAD in a 12-year-old boy
AU - Tatewaki, Hideki
AU - Masuda, Munetaka
AU - Nishida, Takahiro
AU - Kaji, Yoshikazu
AU - Ushinohama, Hiroya
AU - Morita, Shigeki
AU - Yasui, Hisataka
N1 - Funding Information:
Cardiopulmonary bypass was initiated with ascending aorta and bi-caval venous cannulation in the operating room. Interatrial groove was dissected and two pursestring sutures with pledgets were placed in the left atrial wall posterior to the interatrial groove. A 32-French angled venous cannula was placed directly into the left atrial through this area. This venous cannula and the aortic cannula were connected to the ABIOMED BVS 5000 (Abiomed, Inc). The patient was weaned from cardiopulmonary bypass and supported by the LVAD. Flow was maintained around 4.0 L/min (3.0 L/min/m After 4 weeks of support, the patient was successfully weaned off the LVAD. An electrophysiological study showed that the ectopic rhythm originated from the left atrial, and flecainide effectively suppressed this ectopic rhythm ( Echocardiography performed 2 weeks after the removal of the LVAD revealed further improvement of LV function with an ejection fraction of 63% and an end-diastolic diameter of 46 mm. Plasma natriuretic peptide type A and B concentrations decreased to 28 and 32.2 pg/mL, respectively. The boy was discharged home 4 weeks after removal of the LVAD. Follow-up cardiac echocardiography showed normal cardiac function 2 years after discharge, and he is currently active without limitation. 2 ) throughout the support period. Anticoagulation was maintained with a continuous infusion of heparin to keep activated clotting time 200 to 250 seconds and to keep partial thromboplastin time at approximately 70 seconds. Two days after LVAD implantation, the hemodynamic state improved enough to allow weaning off the inotropes. However, ectopic atrial tachycardia persisted despite trying β-blockers, digitalis, pilsicainide, bepridil, and diltiazem. A viral myocarditis was ruled out by negative antibody titers to common viruses. In addition, the boy had been afebrile during the hospitalization. After 3 weeks of LVAD support, flecainide was successfully used to restore sinus rhythm. Subsequently, the LV function improved ( Fig 1 ). Fig 2 ).
PY - 2005/8
Y1 - 2005/8
N2 - Tachycardia-induced cardiomyopathy is an unusual cardiac disease that is life-threatening if tachycardia is not controlled. We report a 12-year-old boy who suffered from ectopic left atrial tachyarrhythmia that was refractory to medications and caused tachycardia-induced cardiomyopathy with severe heart failure. The patient required a left ventricular assist device (ABIOMED BVS5000 [ABIOMED Inc, Danvers, MA]) as a bridge to recovery. Tachycardia was finally controlled with flecainide while the patient was on left ventricular assist device support. The device was successfully explanted after 28 days of support. The temporary use of a left ventricular assist device was necessary to maintain a good hemodynamic status during the treatment of pharmacological refractory tachycardia, and it allowed a successful bridge to recovery.
AB - Tachycardia-induced cardiomyopathy is an unusual cardiac disease that is life-threatening if tachycardia is not controlled. We report a 12-year-old boy who suffered from ectopic left atrial tachyarrhythmia that was refractory to medications and caused tachycardia-induced cardiomyopathy with severe heart failure. The patient required a left ventricular assist device (ABIOMED BVS5000 [ABIOMED Inc, Danvers, MA]) as a bridge to recovery. Tachycardia was finally controlled with flecainide while the patient was on left ventricular assist device support. The device was successfully explanted after 28 days of support. The temporary use of a left ventricular assist device was necessary to maintain a good hemodynamic status during the treatment of pharmacological refractory tachycardia, and it allowed a successful bridge to recovery.
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U2 - 10.1016/j.athoracsur.2005.04.023
DO - 10.1016/j.athoracsur.2005.04.023
M3 - Article
C2 - 16039171
AN - SCOPUS:22544443610
VL - 80
SP - e5
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 2
ER -