AtrioventricularDissociationduringVentricularFibrillation心室颤动时房室分离_NEJM音频
A50-year-oldwomanwithahistoryofbicavalcardiactransplantationpresentedtotheemergencydepartmentwitha1-weekhistoryofdyspnea,fatigue,andweightgain.Atransthoracicechocardiogramshowednewlyreducedleftventricularsystolicfunction,andanendomyocardialbiopsyconfirmedacutecellularrejectionofthetransplantedheart.Herhemodynamicstatusdeteriorated,therebypromptinginitiationofvenoarterialextracorporealmembraneoxygenation.Sustainedventricularfibrillationdeveloped,withalossofrightandleftventricularcontractility,asindicatedbyanonpulsatilepulmonaryarterialwaveformandsystemicarterialwaveform.Aregularpulsatilecentralvenouswaveformwasobserved.Repeattransthoracicechocardiographyconfirmednearventricularstandstillwithaleftventricularthrombusandpreservedrightatrialcontractilitywithtricuspidvalveopening(seethevideoatNEJM.org).Thisobservation,coupledwithcon