ArticleMedicine2025
Atrial overdrive pacing in drug-refractory postinfarction electrical storm case report.
Article in Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
rationaleDrug-refractory electrical storm (ES) following acute myocardial infarction (AMI) constitutes a critical therapeutic challenge. Atrial overdrive pacing (AOP) provides physiological rhythm control by suppressing ventricular ectopy through synchronized atrioventricular activation, circumventing ventricular pacing-associated hemodynamic compromise. PATIENT CONCERNS: A 62-year-old female with AMI developed recurrent polymorphic ventricular tachycardia/ventricular fibrillation refractory to antiarrhythmics (amiodarone/esmolol/lidocaine) and revascularization, fulfilling ES criteria. DIAGNOSES: The patient was diagnosed with acute anterior wall myocardial infarction, Killip class II-III acute left heart failure, secondary hepatic dysfunction, hypertension, type 2 diabetes mellitus and ES.
interventionsX-ray-guided temporary AOP (95 bpm) via subclavian access was implemented with concurrent β-blocker/sacubitril-valsartan optimization and electrolyte correction. Antiarrhythmics were discontinued post-AOP. OUTCOMES: Sustained arrhythmia suppression was achieved (0 recurrences/9 months), alongside improved left ventricular ejection fraction (40%→46%) and 70.7% N-terminal B-type natriuretic peptide precursor reduction (33,593→9839 pg/mL). Implantable cardioverter-defibrillator was declined without clinical sequelae. LESSONS: AOP demonstrates dual therapeutic efficacy in refractory post-AMI ES: (1) physiological conduction restoration suppressing ectopic triggers and (2) avoidance of ventricular pacing-induced dyssynchrony. Fluoroscopic guidance ensures lead stability, positioning AOP as a hemodynamically favorable intervention in ES management.
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