Management of sustained arrhythmias for patients with cardiogenic shock in intensive cardiac care units

Abstract

Cardiac arrhythmias that occur in patients referred to intensive care units worsen symptoms and outcomes and need urgent correction, especially in patients admitted for refractory heart failure. Electrical storm is a frequent reason for referral to an intensive care unit. Specific, efficient and rapid management of patients presenting with various arrhythmias is therefore mandatory and procedures should be known by any physician involved in an intensive care unit. This article reviews the current knowledge on the management of supraventricular and ventricular arrhythmias in this setting, from medications and sedation to ablation and more exceptional therapy. It also covers the occasional indications of resynchronization in refractory heart failure and the interest for haemodynamic assistance when specific therapy fails.

Keywords: Ablation par cathéter; Atrial fibrillation; Cardiogenic shock; Catheter ablation; Choc cardiogénique; Electrical storm; Fibrillation atriale; Orage rythmique.