Un altro importante traguardo raggiunto dal Dipartimento di Aritmologia di ClinicaPierangeli, volto all’ottimizzazione e alla personalizzazione degli approcci procedurali: l’ablazione della tachicardia ventricolare eseguita con ECMO MOBYBOX (Hemovent) per il supporto circolatorio avanzato.
Il paziente, di età superiore ai 70 anni, si presentava con tempesta aritmica (oltre 50 interventi ICD nell’arco di 48 ore) secondaria a cardiomiopatia non ischemica (NICM), con frazione di eiezione (EF) <20%. The patient had an implantable cardioverter-defibrillator (ICD) with spontaneous rhythm and a narrow QRS, as well as cardiac contractility modulation (CCM) therapy. The PAINESD score was 25.
The patient exhibited extreme frailty, hypotension, and a very high anesthetic risk, along with significant arrhythmic burden and non-ischemic cardiomyopathy. Multiple comorbidities—such as an inability to undergo MRI or CT imaging due to device incompatibility and chronic kidney disease (GFR <30 ml/min)—further complicated the clinical scenario. In light of these challenges, we opted to utilize femoro-femoral extracorporeal membrane oxygenation (ECMO) for circulatory support during the procedure (the initial femoro-jugular cannulation did not provide adequate flow).
The procedural outcome was excellent, with no perioperative complications. Continuous circulatory support was maintained throughout the procedure, avoiding the intraventricular obstruction often associated with other devices.
The cannulas (17Fr arterial and 23Fr venous) were removed using an arterial closure device and an 8-suture venous closure technique. The patient was successfully discharged 72 hours post-procedure.
Stefano Guarracini, Andrea Italiano
I extend my personal heartfelt thanks to Michele Di Mauro for his assistance and for sharing his cardiothoracic and academic expertise in the choice and use of ECMO, as well as to the entire anesthesiology team for their outstanding and invaluable support in managing this high-risk case.
Special thanks also to hashtag#abbott and hashtag#Hemovent for their invaluable support. Stefano Vincenti
