Morgan L. Montgomery, MD, Mehdi Oloomi, MD, Ahmed El-Eshmawi, MD, David H. Adams, MD
PATIENTS WITH coronary artery disease and left ventricular dysfunction are at risk for cardiac arrest after coronary artery bypass grafting (CABG) surgery. In fact, the highest risk of cardiac arrest is in the first 3 months after CABG, and the most common mechanism for cardiac arrest is ventricular fibrillation (VF). The development of VF has a significant effect on early mortality after CABG, and VF storm (defined as 3 or more sustained episodes in a 24-hour period) is associated with an even worse prognosis. Establishing the mechanism and initiating therapies to reduce recurrent episodes of VF remain diagnostic and therapeutic challenges. Causes of VF after CABG can include myocardial ischemia (eg, occluded grafts); electrolyte derangements; metabolic disturbances; and pacing-induced R-on-T (temporary epicardial pacing wire). In addition, premature ventricular contractions (PVCs), especially those arising from the Purkinje system, can trigger VF. Accurate identification and treatment of PVC-triggered VF can affect recurrence rates significantly. Herein, the authors present a case of the diagnosis and management of drug-refractory recurrent PVC-triggered VF arising from the anterolateral papillary muscle after recent myocardial infarction and CABG.
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- Ahmed El-Eshmawi, MD, Dimosthenis Pandis, MD, David H. Adams, MD, Gilbert H. Tang, MD
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