Extracorporeal Membrane Oxygenation-Assisted Ablation of Extremely Refractory Purkinje Ventricular Fibrillation.

BACKGROUND: Fascicular ventricular arrhythmias represent a spectrum of disease ranging from premature ventricular contraction, idiopathic ventricular tachycardia to idiopathic Purkinje ventricular fibrillation (VF). In the most severe cases, VF can become refractory to many therapies and require emergency ablation with hemodynamic support. CASE SUMMARY: We present a case of a 42-year-old man with no significant past medical history who presented with refractory VF that required over 100 shocks and eventual extracorporeal membrane oxygenation-assisted ablation. DISCUSSION: Extreme presentations of Purkinje VF are rare with few multicenter reports in the literature informing prognosis and best practices. This pathophysiology is postulated to involve the Purkinje-myocardial junction. TAKE-HOME MESSAGES: Timely recognition of refractory VF and the need for advanced hemodynamic support is critical for yielding a good outcome. This case highlights the importance of bystander cardiopulmonary resuscitation and highly coordinated care among specialties yielding many lessons learned and an excellent outcome.