In atrial and ventricular tachyarrhythmias, reduced time for ventricular filling and loss of atrial contribution lead to a significant reduction in cardiac output, resulting in cardiogenic shock. This may also occur during catheter ablation in 11% of overall procedures and is associated with increased mortality. Managing cardiogenic shock and (supra) ventricular arrhythmias is particularly challenging. Inotropic support may exacerbate tachyarrhythmias or accelerate heart rate; antiarrhythmic drugs often come with negative inotropic effects, and electrical reconversions may risk worsening circulatory failure or even cardiac arrest. The drop in native cardiac output during an arrhythmic storm can be partly covered by the insertion of percutaneous mechanical circulatory support (MCS) devices guaranteeing end-organ perfusion. This provides physicians a time window of stability to investigate the underlying cause of arrhythmia and allow proper therapeutic interventions (e.g., percutaneous coronary intervention and catheter ablation). Temporary MCS can be used in the case of overt hemodynamic decompensation or as a "preemptive strategy" to avoid circulatory instability during interventional cardiology procedures in high-risk patients. Despite the increasing use of MCS in cardiogenic shock and during catheter ablation procedures, the recommendation level is still low, considering the lack of large observational studies and randomized clinical trials. Therefore, the evidence on the timing and the kinds of MCS devices has also scarcely been investigated. In the current review, we discuss the available evidence in the literature and gaps in knowledge on the use of MCS devices in the setting of ventricular arrhythmias and arrhythmic storms, including a specific focus on pathophysiology and related therapies.

Adult Intensive Care Unit Royal Brompton Hospital London United Kingdom

Cardiovascular Center Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium

Centre for Inherited Cardiovascular Diseases Fondazione IRCCS Policlinico San Matteo Pavia Italy

Department of Anaesthesia Intensive Care and Pain Therapy Fondazione IRCCS Policlinico San Matteo Pavia Italy

Department of Anesthesiology and Intensive Care 1st Medical Faculty and General University Hospital Charles University Prague Prague Czechia

Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium

Department of Cardiovascular Sciences KU Leuven Leuven Belgium

Department of Clinical Surgical Diagnostic and Paediatric Sciences University of Pavia Pavia Italy

PhD in Experimental Medicine University of Pavia Pavia Italy

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