Acute and Critical Care

Cardiology
Implantable cardioverter defibrillator as a treatment for massive left ventricular fibroma-induced ventricular arrhythmia in a child: In Su Choi, Hyung Ki Jeong, Hyung Wook Park, Yi-Seul Kim; Acute Crit Care. 2021;36(2):164-168. Published online May 28, 2021; DOI: https://doi.org/10.4266/acc.2020.00269

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Pediatric cardiac tumors are rare. Among these, cardiac fibroma is the second most common. Its clinical manifestations depend on size and location of the tumor and include arrhythmia or obstruction to blood flow. Symptomatic cardiac fibroma is generally treated with surgical resection or cardiac transplantation. We present the case of a 12-year-old boy with a lethal ventricular arrhythmia induced by a remnant tumor that was previously partially resected. An implantable cardioverter defibrillator was inserted as the arrhythmia was resistant to medical treatment. He was discharged in stable condition with an implantable cardioverter defibrillator generator and followed up in the outpatient clinic.

Citations

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Lipid emulsion attenuates propranolol-induced early apoptosis in rat cardiomyoblasts
Seong-Ho Ok, Seung Hyun Ahn, Soo Hee Lee, Hyun-Jin Kim, Gyujin Sim, Jin Kyeong Park, Ju-Tae Sohn
Human & Experimental Toxicology.2022; 41: 096032712211108. CrossRef

CPR/Resuscitation
Successful resuscitation of refractory ventricular fibrillation with double sequence defibrillation: SungJoon Park, Jung-Youn Kim, Young-Duck Cho, Eusun Lee, Bosun Shim, Young-Hoon Yoon; Acute Crit Care. 2021;36(1):67-69. Published online October 21, 2020; DOI: https://doi.org/10.4266/acc.2020.00122

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Abstract PDF

In cardiac arrest, if the initial rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia, the survival rates are high and good neurologic outcomes are expected. However, the mortality rate increases when refractory ventricular fibrillation (RVF) occurs. We report a case of RVF that was successfully resuscitated with double sequence defibrillation (DSD). A 51-year-old man visited the emergency department with chest pain. The initial electrocardiography showed markedly elevated ST-segment on V1–V5 leads, and VF arrest occurred. Although 10 defibrillations were administered over 20 minutes, there was no response. Two rounds of DSD were performed by placing additional pads on the patient’s anterior-posterior areas and sequentially applying the maximum energy setting. The patient returned to spontaneous circulation and was discharged with cerebral performance category 1 after 14 days of hospital admission. Therefore, DSD could be an option for treatment and termination of RVF.

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Keep shocking: Double sequential defibrillation for refractory ventricular fibrillation
Ahmed Kamal Mohamed, Mohamed Shakaib Nayaz, Ali Nawaz, Carl B Kapadia
The American Journal of Emergency Medicine.2023; 63: 178.e5. CrossRef

Cardiology
Thrombosis in the Left Ventricle after Implantable Cardioverter-Defibrillator Implantation: A Rare Cause of Systemic Thromboembolism: Hee Chan Jung, Woo Baek Chung, Man Young Lee; Korean J Crit Care Med. 2014;29(1):27-31. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.27

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Abstract PDF: This report describes a case of systemic thromboembolism caused by left ventricular (LV) thrombosis that developed after placement of an implantable cardioverter-defibrillator (ICD). A 27-year-old male patient was diagnosed with idiopathic dilated cardiomyopathy and ventricular tachycardia, and underwent ICD implantation for the primary prevention of sudden cardiac death. Two weeks after ICD implantation, the patient experienced renal infarction. Transthoracic echocardiography revealed a mobile thrombus at the LV apex, and automated function imaging demonstrated deteriorated LV function after ICD implantation. The RV was not placed by ICD and the mechanical force which was occurred by ICD that led to induced dyssynchronous motion of the LV apex may have resulted in a systemic thromboembolism.

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