Successful treatment of refractory cardiogenic shock and electrical storm using the impella 5.0 with atrial overdrive pacing, in a patient with severe peripheral arterial disease

Abstract

Cardiogenic shock with electrical storm is a challenging condition to manage in patients with acute myocardial infarction despite primary percutaneous coronary interventions. While active mechanical circulatory support devices may improve hemodynamics in this situation, identifying the appropriate arterial access for device deployment is difficult in patients with severe peripheral arterial disease due to severe stenosis or obstruction and tortuous path of the femoral-iliac artery or descending aorta; additionally, this also reduces the mechanical viability of the implanted circulatory support devices, thus posing a risk for limb ischemia. Herein, we report on the effectiveness of the IMPELLA 5.0, deployed via the axillary artery, in combination with atrial overdrive pacing to manage a patient with cardiogenic shock and electrical storm, without extracorporeal membrane oxygenation. Our strategy, which does not require access via the groin area, may be an attractive option for patients with severe peripheral arterial disease, particularly those with aorto-iliac occlusive disease.