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.