Levosimendan for management of cardiogenic shock with electrical storm - A case report

Abstract

Background: Levosimendan, an inotrope and vasodilator, is a second-line treatment for cardiogenic shock. One of its main advantages is its prolonged effect compared to Dobutamine. Case presentation: Our reports show two cases of successful treatment with levosimendan involving patients presenting in a state of cardiogenic shock with electrical storm, which had never been described before. Levosimendan infusion, with no initial bolus dose, enabled us to correct the low cardiac output in both cases, with no secondary rhythm disturbances. Apart from the absence of any pro-arrhythmic effect, infusion of Levosimendan allowed a double angioplasty to be performed under optimal haemodynamic conditions in the first case; and provided us sufficient time to reflect on implantable cardioverter defibrillator implantation with resynchronization due to its conversion into active metabolites in the second case. Conclusion: Through the neutral effects of levosimendan on heart rhythm and the absence of Myocardial oxygen consumption (MvO2) increasing, these two cases show the feasibility and safety of levosimendan treatment in this indication; and emphasise levosimendan’s lack of pro-arrhythmic effect when used without a bolus dose. its its prolonged effect This discusses two clinical cases of patients to care with shock and treated by Levosimendan. these two cases, we will discuss the absence of a pro-arrhythmic effect.