Recovery from long lasting life-threatening ventricular arrhythmia associated with fulminant myocarditis

A 39-year-old woman was referred because of a chest discomfort following flu symptoms (high grade fever, headache and arthralgia) in January 2008. Her consciousness was drowsy and her blood pressure was 86/62. Electrocardiogram revealed accelerated idioventricular rhythm (P and QRS rates were 140/min and 86/min respectively) (Fig. 1A). Chest X-ray showedmild lung congestionwith slight cardiac enlargement. A laboratory examination showed the following data: white blood cell count 9600/μL, asparate aminotransferase 442 IU/L, alanine aminotransferase 130 IU/L, lactate dehydrogenase 846 IU/L, creatine phosphokinase (CPK) 7298 IU/L, Na 135 mEq/L, K 5.9 mEq/L, C-reactive protein 6.94 mg/dL. Echocardiographic left ventricular (LV) wall motion was extremely reduced (LV ejection fraction of 17%) without valvular disease. Emergent coronary angiogram revealed normal coronary arteries. Just after admission, the accelerated idioventricular rhythm changed into a faster ventricular tachycardia (VT, cycle length of 444 ms) abruptly, then she collapsed (Fig. 1B). Lidocaine hydrochloride, Magnesium sulfate, nifekalant hydrochloride and direct current cardioversions (16 attempts on the first day) could not terminate this VT. Because of cardiogenic shock, intensive therapy with mechanical cardiac support should be started; PCPS, IABP and mechanical ventilation were required. PCPS and IABP were set through right and left femoral approaches, respectively. PCPS equipment was set as follows: membrane oxygenator and pump