///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Management of New-Onset Refractory Ventricular Tachycardia in Pregnancy

Abstract Number: RF1AA-121
Abstract Type: Case Report Case Series

Jessica M. Meister Berger MD, JD1 ; Paul S. Pagel MD, PhD2; Lonnie Dye III MD3

Case: A 34-year-old G4P1021 parturient presented at 25-weeks’ gestation with palpitations, fatigue, and tachycardia (HR=160 beat/min) without hypotension. An electrocardiogram demonstrated sustained monomorphic ventricular tachycardia (VT). She was treated with lidocaine and amiodarone. Cardiac MRI demonstrated left ventricular (LV) systolic dysfunction and multiple areas of LV wall thinning in a coronary distribution. Transthoracic echocardiography (TTE) confirmed an enlarged LV; the ejection fraction was 36%. Coronary angiography was unremarkable. The patient was treated with metoprolol and furosemide. An AICD was placed at 29-weeks’ gestation. Three weeks later, she developed recurrent palpitations and dyspnea. Repeat TTE showed further deterioration of LV function and severe pulmonary hypertension. The patient underwent a cesarean section in a hybrid OR under epidural anesthesia with invasive radial and pulmonary artery catheter monitoring. Cardiothoracic surgery was available for ECMO in case her condition worsened. The operation was uneventful: a 1340-gram infant was delivered with Apgar scores of 5,7, and 8. The patient required postoperative diuresis and pharmacologic rate control in the ICU. Extensive workup did not reveal a clear etiology; ultimately her VT was attributed to myocardial scarring from recurrent coronary vasospasm.

Discussion: VT during pregnancy is rare and is an independent predictor of adverse maternal and fetal outcome1. Predisposing risk factors for VT during pregnancy include congenital heart disease, prolonged QT syndrome, aberrant conduction, pulmonary embolism, and electrolyte abnormalities2. VT during pregnancy may be also attributed to increased sympathetic nervous system activity3. The most common arrhythmogenic focus for idiopathic VT during pregnancy is the RV outflow tract caused by hormonal fluctuations of myocardial norepinephrine concentration4. Management of VT during pregnancy depends on hemodynamic stability: rate control with a selective beta1-adrenoceptor antagonist is considered first-line therapy in stable patients5, whereas cardioversion is recommended regardless of gestational age in the presence of hemodynamic instability or fetal compromise6.

References:

1. Circulation 2001;104:515–21

2. Med Insights Cardiol 2010;4:39-44

3. Int J Cardiol 2003;88:129–33

4. Basic Res Cardiol 2001;96:91–7

5. Am Heart J 1992;123(4 Pt 1):933–41

6. Br J Clin Pract 1979;33:88–94

SOAP 2019