Atrial Fibrillation and Cardiogenic Shock

Case Report: Fatal atrioesophageal fistula following atrial fibrillation ablation—critical reflections on prevention

Frontiers in Cardiovascular Medicine

FEBRUARY 24, 2025

Radiofrequency ablation (RFA) is an important therapeutic modality for atrial fibrillation (AF), widely utilized in clinical practice due to its safety and significant efficacy. Head CT scans showed hypoattenuating areas indicative of cerebral infarction, chest CT suggested possible air accumulation in the left atrial region.

Atrial Fibrillation

Atrial Fibrillation Ablation Cardiogenic Shock Myocardial Infarction

PO-03-062 CARDIOVERSION IN CARDIOGENIC SHOCK PATIENTS WITH ATRIAL FIBRILLATION: IMPACT ON OUTCOMES AND MORTALITY RISK IN A US NATIONWIDE ANALYSIS

HeartRhythm

APRIL 30, 2024

Atrial fibrillation (AF) is a common sequela in cardiogenic shock (CS) and portends a worse prognosis. Despite its potential to worsen shock, no large-scale studies have investigated the impact of CV on patient outcomes. Electrical cardioversion (CV) is often employed for sinus rhythm restoration.

Cardiogenic Shock

Cardiogenic Shock Atrial Fibrillation Outcomes

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The rhythm now is atrial fibrillation. Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. A repeat ECG was recorded about 15 minutes after the initial ECG.

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

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3 days of shoulder and chest pain, and now cardiogenic shock

Dr. Smith's ECG Blog

AUGUST 28, 2020

Now appears to be in cardiogenic shock." However, cardiogenic shock usually takes some time to develop, so it is probably subacute." ECG from 2 days later: Atrial Fibrillation now. Cardiogenic shock and ACS is an indication for the cath lab, even if you don't think there is OMI.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Ischemia Stenosis

PO-02-034 CARDIOGENIC SHOCK AND PNEUMOPERICARDIUM: A RARE PRESENTATION OF ATRIOESOPHAGEAL FISTULA

HeartRhythm

APRIL 30, 2024

Atrioesophageal fistula (AEF) is a rare but lethal complication of radiofrequency atrial fibrillation ablation. Symptoms are frequently non-specific, and generally include fevers, rigors, focal neurological deficits, and seizures. A high index of suspicion is needed to guide early diagnosis and surgical management.

Cardiogenic Shock

Cardiogenic Shock Atrial Fibrillation Ablation

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

DAIC

FEBRUARY 29, 2024

24 will focus on the following three current guideline updates: American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines 2023 Atrial Fibrillation Guideline - Pharmacology II: Strokes vs. Bleeds, What Do the Guidelines Tell Us About Practical Management in A-fib? The Guidelines Sessions at ACC.24

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. This patient’s severe aortic stenosis (AS) and associated severe cardiogenic shock likely created the ECG pattern, resulting in a very difficult challenge for our inpatient team. If you can use Doppler, then you can diagnose it. Circulation.

Ischemia

Ischemia Cardiogenic Shock Aortic Stenosis

Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Another frequent feature of hypothermia is atrial fibrillation (not seen in this case) Core temperature of this patient was 29,5 Celsius. The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. Prominent J waves of this morphology thus are called Osborn waves.

Ischemia

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Dr. Smith's ECG Blog

MAY 30, 2023

What is the atrial activity? Or is it atrial fibrillation with complete AV block and junctional escape? He appeared gray in color, with cool skin. Here is his ED ECG: There is bradycardia with a junctional escape. Is it sinus arrest with junctional escape? There is an obvious inferior posterior STEMI(+) OMI.

Chest Pain

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

Dr. Smith's ECG Blog

JULY 18, 2014

Description There is atrial fibrillation at a rate of 95. Case Continued 2 days later the patient became increasingly tachycardic, hypotensive, ashen, clammy (in cardiogenic shock) and had a new murmur. He had walked into the ED (did not use EMS). He was in no distress and vital signs were normal. Obviously there is MI.

STEMI

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock

Chest discomfort, Sinus Tachycardia, Q-waves, ST Elevation, and Intermittent Wide Complex Tachycardia. Activate the Cath Lab?

Dr. Smith's ECG Blog

AUGUST 13, 2020

Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenic shock. Looks like atrial fibrillation. Still Irregular Blood pressure during these rhythms was adequate; there was no shock. Not all anterior LV aneurysm has a QS-wave.

Tachycardia

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. Chart review confirmed that he had been started on flecainide for atrial fibrillation. Atrial Flutter with Inferior STEMI? Is this inferor STEMI?

Ischemia

Ischemia Atrial Flutter Arrhythmia Tachycardia

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. Left main? 3-vessel disease?

Ischemia

Ischemia STEMI Stenosis Chest Pain

Published Research

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Institutional Coronary Artery Bypass Case Volumes and Outcomes European Journal of Heart Failure October 2023 Makoto Mori Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation The Annals of Thoracic Surgery August 2023 Carlos Diaz-Castrillion Volume-Failure to Rescue Relationship in Acute Type A Aortic Dissections: An Analysis of The Society (..)

Research

Research Coronary Artery Bypass Graft Aortic valve Congenital

Published Research

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Institutional Coronary Artery Bypass Case Volumes and Outcomes European Journal of Heart Failure October 2023 Makoto Mori 1 Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation The Annals of Thoracic Surgery August 2023 Carlos Diaz-Castrillion 2 Volume-Failure to Rescue Relationship in Acute Type A Aortic Dissections: An Analysis of The (..)

Research

Research Coronary Artery Bypass Graft Aortic valve Congenital

Pulmonary edema, with tachycardia and OMI on the ECG -- what is going on?

Dr. Smith's ECG Blog

MARCH 3, 2025

Whenever there is tachycardia, I am skeptical of OMI unless it has led to severely compromised ejection fracction with cardiogenic shock. increasing stenosis, ischemia, volume changes, increased blood pressure, atrial fibrillation, etc.) Or I suspect that there is OMI simultaneous with another pathology.

Tachycardia

Tachycardia Pulmonary Chest Pain Stenosis

Cardiovascular Update

Case Report: Fatal atrioesophageal fistula following atrial fibrillation ablation—critical reflections on prevention

PO-03-062 CARDIOVERSION IN CARDIOGENIC SHOCK PATIENTS WITH ATRIAL FIBRILLATION: IMPACT ON OUTCOMES AND MORTALITY RISK IN A US NATIONWIDE ANALYSIS

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Webinars

3 days of shoulder and chest pain, and now cardiogenic shock

PO-02-034 CARDIOGENIC SHOCK AND PNEUMOPERICARDIUM: A RARE PRESENTATION OF ATRIOESOPHAGEAL FISTULA

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Should we activate the cath lab? A Quiz on 5 Cases.

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

Chest discomfort, Sinus Tachycardia, Q-waves, ST Elevation, and Intermittent Wide Complex Tachycardia. Activate the Cath Lab?

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Published Research

Published Research

Pulmonary edema, with tachycardia and OMI on the ECG -- what is going on?

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