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case_images: (A) ECG strip from the ambulance. The initial ECG strip taken in the ambulance shows sustained wide-complex tachycardia with frequency around 180 b.p.m. (B) ECG strip on admission. This strip taken on admission shows sinus rhythm with pathological ST elevation in leads I, aVL, V1-V5 and deep Qs in leads V1-V3. ECG, electrocardiogram.
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case_images: The initial ECG obtained from the ambulance revealed sustained VT (Figure  1 A ). Upon admission, the subsequent ECG displayed sinus rhythm, into which he spontaneously converted during transport; pathological ST elevations were seen in leads I, aVL, and V1-V5, and deep Q waves were noted in leads V1-V3 (Figure  1 B ).
case_images: (A) CMR performed in the acute phase of CS. The cardiac magnetic resonance shows several foci (interventricular septum, apicolateral segment of the LV) of midmyocardial late gadolinium enhancements (arrows) of non-ischaemic aetiology. (B) CMR after 8 weeks. The cardiac magnetic resonance shows no areas of late gadolinium enhancements. The EF of LV was 49%.
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case_images: Endomyocardial biopsy [haematoxylin and eosin (HE) staining] and immunohistochemistry of the myocardium. There is visible diffuse infiltration of the myocardium with occasional more compact deposits of inflammation. In immunohistochemistry, there is an infiltration by two types of cells. (A) HE staining: 100x original magnification, (B) HE staining: 400x original magnification, (C) CD3 positive cells:T lymphocytes, (D) CD163 positive cells:histiocytes.
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case_images: Immediately after the ECMO implantation, an EMB was performed with preliminary results suggestive of acute necrotizing lymphocytic myocarditis (Figure 3).
case_images: The arterial line indicates minimal pulsatility of the left ventricle.
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case_images: The patient was on ECMO and Impella for 5 days with minimal LV pulsatility (Figure 4).
case_images: Photo of the patient's groins after the explantation of both MCS. The explantation was done fully percutaneously, and the groins were closed using AngioSeal and ProGlide. Impella was inserted via right femoral artery, the venous cannula of ECMO was implanted via right femoral vein (A) and arterial cannula was implanted via left femoral artery (B). In panel (B), there is visible a central venous catheter inserted via left femoral vein.
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case_images: This enabled us to slowly wean off ECMO, with successful fully percutaneous explantation of both the Impella and ECMO on the 8th and 9th days post-implantation, respectively (Figure  5 ).Details of the laboratory results are presented in Figure 6.
case_images: Laboratory results: Initial 10-day observations. The following data are presented in a condensed format, with the highest value recorded for each day denoted: (A) lactate levels: lactate concentrations were repeatedly assessed throughout each day, with the maximum value recorded for each 24-h period. (B) C-reactive protein (CRP). (C) Serum creatinine. (D) White blood cell (WBC) count. (E) procalcitonin (PCT). (F) Highly sensitive troponin (hs-cTnI).
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case_images: This enabled us to slowly wean off ECMO, with successful fully percutaneous explantation of both the Impella and ECMO on the 8th and 9th days post-implantation, respectively (Figure  5 ).Details of the laboratory results are presented in Figure 6.