Abstract

Background

Atrial and ventricular arrhythmias are common in the critically ill due to a variety of factors including sepsis, myocardial ischaemia, renal dysfunction, and electrolyte disturbances. Anti-arrhythmic medications can be useful to control arrhythmias but can result in bradycardia and haemodynamic compromise. A paced atrial rhythm alongside normal atrioventricular conduction can be helpful to treat bradycardia, prevent arrhythmias, and support cardiac output.

Case summary

A 55-year-old gentleman with pseudomonas pneumonia, respiratory failure necessitating mechanical haemodynamic support, and subsequent coronary ischaemia presented to the intensive care unit. Paroxysms of atrial fibrillation and ventricular arrhythmias caused haemodynamic embarrassment and presented an ongoing clinical challenge as anti-arrhythmic medications resulted in bradycardia and Torsade de Pointes. Atrial pacing mediated intrinsic conduction via the His-Purkinje system inhibited ventricular ectopy and further arrhythmia breaking the tachycardia—bradycardia cycle; this stabilized the patient, facilitated ongoing intensive therapy unit care and promoted recovery.

Conclusion

Atrial pacing mediated intrinsic conduction via the His-Purkinje system is an effective approach to suppress ventricular ectopy and sustained arrhythmias whilst protecting the patient from haemodynamically compromising bradycardia.

Details

Title
Atrial pacing to suppress ventricular arrhythmias in the critically ill patients: a case report
Author
Riad, Omar 1 ; Russell, Clare 2 ; Garfield, Ben 2 ; Behar, Jonathan M 1 

 Cardiology Department, Royal Brompton Hospital , Sydney Street, London SW3 6NP, UK 
 Department of Adult Intensive Care, Royal Brompton Hospital , Sydney Street, London SW3 6NP, UK 
Publication year
2022
Publication date
May 2022
Publisher
Oxford University Press
e-ISSN
25142119
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3169595473
Copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. This work is published under https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.