Case: 42 y.o. male. Chief Complaint: Dyspnea. Present History: Mitral valve replacement and myectomy was performed for familial hypertrophic obstructive cardiomyopathy. AF had been chronic for over than 10 years. He admitted to our hospital because of rapid atrial fibrillation and acute exacerbation of chronic heart failure. Clinical Course: On admission day 6, fever and following respiratory failure resulted in sudden cardiopulmonary arrest. CPR was immediately started, however, asystole continued. Venoarterial extracorporeal membrane oxygenation(VA-ECMO) and intra-aortic balloon pumping(IABP) was initiated to regain systemic circulation. On admission day 13, right heart catheter showed meanPAP of 29 mmHg, meanPCWP of 26 mmHg and cardiac index of 1.14L/min/m2 which showed the patients still in severe heart failure. The indication of heart transplantation was thought to be inadequate because of poor family support. We started administration of intra-venous beta blocker and amiodarone because poorly controlled heart rate(130–150 beat/min) was believed to be a key for overcoming the situation. According to heart rate reduction, cardiac index gradually improved, which resulted in VA-ECMO withdrawal on admission day 22. On day 25, IABP was also removed and on Day 27 extubated. Discussion: We experienced a case that intravenous administration of beta blocker and amiodarone was helpful for VA-ECMO withdrawal in a patient with severe heart failure. Intravenous Beta blocker and amiodarone can be safely introduced in the patients with critical severe heart failure.
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