Abstract: A patient with atrial fibrillation admitted for an
elective electrical cardioversion. He was given an amiodarone bolus that
triggered Kounis syndrome with cardiac arrest (CA) and refractory shock
needing mechanical support with ECMO and refractory hypoxemia that
improved with inhaled nitric oxide. Allergy to amiodarone was later
confirmed.Introduction
Atrial fibrillation is the most common supraventricular arrhythmia. Some
studies revealed benefits in maintaining sinus rhythm in patients with
AF, especially in young patients (1). Electrical cardioversion is an
option when pharmacological cardioversion fails.
Kounis syndrome (2) is a rare disease that consists of an allergic
coronary syndrome, it usually presents as an ST-segment elevation acute
coronary syndrome. It requires emergent coronary angiography with
intracoronary vasodilators infusion and angioplasty if required. We
present an unusual form of Kounis Syndrome triggered by endovenous
amiodarone that underwent with cardiorespiratory arrest and refractory
shock due to the vasospasm. In this situation mechanical circulatory
support with ECMO was necessary to ensure tissue perfusion.
Specifically, in the in-hospital cardiac arrest, ECMO implantation is an
expanding therapy and is showing promising results.