Introduction
There are currently no guideline recommendations regarding pulmonary
vein isolation (PVI) and posterior wall isolation (PWI) in the setting
of refractory atrial fibrillation with a rapid ventricular response
(AF/RVR) and cardiogenic shock. Atrioventricular nodal (AVN) ablation
and pacemaker insertion have been the go-to treatment of choice. The
fact that AVN ablation is a shorter procedure and does not overbear the
already compromised hemodynamics makes it an attractive treatment
option. PVI/PWI, though superior to AVN ablation and pacemaker
insertion, is rarely performed in the hemodynamically compromised
patient (1).
Percutaneous Impella CP (Abiomed, Danvers, MA) support during PVI/PWI in
the setting of persistent cardiogenic shock due to pharmacologically and
electrically refractory AF/RVR; to the best of our knowledge has not
been reported in the literature.
We present a case of PVI/PWI on Impella CP support for persistent
cardiogenic shock due to refractory AF/ RVR.