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Quick Case

Patient With Cardiomyopathy Symptoms Experiences Multiple Arrests

Cardiomyopathy-Symptoms-Experiences-Multiple-ArrestsA 51-year-old man who exercised regularly to maintain cardiac function following a diagnosis of low ejection fraction and non-ischemic cardiomyopathy experienced 3 arrests and 1 stroke within a year.

The patient, who had a defibrillator implanted in 2016, experienced his first cardiac arrest a few months later when the device shocked his heart during a workout at a gym. Despite adjustments to the device, the patient experienced a second arrest a few months later at the same gym. Duke heart surgeon Jeffrey G. Gaca, MD, who was working out nearby, revived him at the workout facility.

A defibrillator with cardiac resynchronization capacity was inserted to replace the standard defibrillator, but the patient arrested again when he was a passenger in a car. A nearby motorist performed CPR. He was rushed to the Duke Hospital emergency department in extreme distress and with persistent life-threatening cardiac arrhythmias.

A multidisciplinary team decided to support the patient with extracorporeal membrane oxygenation (ECMO) to stabilize circulation and allow time for assessment. The team attempted to treat his persistent arrhythmia with emergency catheter ablation. During the procedure, the patient experienced a stroke, leaving him with left-sided motor deficits.

Questions: Given the patient’s history, repeated arrests, and stroke, what immediate care was required? What long-term options were considered?

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