///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-06:00

Continuous Spinal Anesthesia for the Management of a Pregnant Patient with Catecholaminergic Polymorphic Ventricular Tachycardia

Abstract Number: SUN-55
Abstract Type: Case Report/Case Series

Maria Cristina Sanchez MD1 ; Jonathan Matias MD2; Manuel Torres MD3; Evelyn Carrero MD4

Introduction: Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a rare disease with a mortality rate of 31% by the age of 30 years. CPVT places patients at high risk of perioperative ventricular tachyarrhythmias with adrenergic stimuli. We discuss the anesthetic management of a 24 y/o G2T0P1A0L0 female with CPVT, who presented for C-section. Case: The patient was referred to our service at 24 WGA with a past medical history remarkable for intermittent BA and peripartum cardiomyopathy. CPVT was diagnosed at 29 WGA of her first pregnancy after development of an arrhythmic storm and cardiac arrest. An implantable cardiac defibrillator was placed shortly after. During her second pregnancy, the patient was referred by her cardiologist to our institution at 24 WGA due to SOB associated to peripartum cardiomyopathy. TTE was remarkable for left ventricular dilatation and hypokinesis and an EF of 35%. EKG presented NSR with occasional PVCs and labile HR ranging from 50-120 noted on telemetry monitoring. Patient was rate controlled with metoprolol and follow-up TTE was unchanged at 32 WGA prior to planned C-section. After standard ASA monitors, a 20G radial arterial line and two 18G peripheral IV lines were established. Continuous Spinal anesthesia (CSA) at L4-L5 with an initial dose of 4.5 mg of 0.75% hyperbaric bupivacaine was given to achieve a T4 dermatome level. Under close hemodynamic monitoring 50 mcg of phenylephrine were administered shortly after. A second dose of 1.5 mg was administered the following hour. MAPs ranged from 74-87 mmHg, while HR ranged from 40-80 bpm. A TAP block was performed at the end of surgery and the spinal catheter removed. The patient was transferred to the surgical intensive care unit with an uneventful postoperative course and adequate analgesia. Discussion: CPVT presents through development of ventricular tachyarrhythmias triggered by adrenergic responses to stress or physical activity. A family history of syncopal episodes or sudden cardiac death exists in 30-35% of patients, and a genetic correlation to mutations in ryanodine 2 receptor gene is found in 50% of patients. Scheduled C-section provides a controlled setting and avoids emergent surgery under possible hemodynamic instability. Single-dose spinal anesthesia has had poor outcomes when compared to GETA, and recent evidence points to potential advantages of regional anesthesia at incremental doses. CSA tends to provide better sensory block with lower doses of medication while maintaining hemodynamic stability.

Ref: 1. Leenhardt A. Circ Arrhythm Electrophysiol. 2012;5:1044-52 2.Dornan RI. Anesth Analg 2002;95:555-7. 3.Chan TM, Dob DP. Ιnt J Obstet Anesth. 2002;11:122-4

SOAP 2017