A neonate with long QT syndrome, refractory ventricular arrhythmias, and lidocaine toxicity.
Long QT syndrome is characterized by electrocardiographic appearance of long QT intervals and propensity to polymorphic ventricular tachycardia. Aggressive anticipatory clinical management is required for a good outcome, especially in the symptomatic neonate. We present a neonate with a compound mutation with refractory ventricular tachycardia that necessitated multimodal pharmacotherapy with lidocaine, esmolol, and amiodarone along with ventricular pacing. Despite normal serum lidocaine levels, complex pharmacokinetic interactions resulted in presumed neurotoxicity due to lidocaine. This report discusses the implications and challenges of management of a neonate with compound long mutations.
Department of Anesthesiology & Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA. aruna.nathan@gmail.com
Aruna T
AT
Nathan
Maryam
M
Naim
Lisa M
LM
Montenegro
Victoria L
VL
Vetter
D000638:Amiodarone / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D002304:Cardiac Pacing, Artificial; D004252:DNA Mutational Analysis; D004347:Drug Interactions; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D006801:Humans; D007231:Infant, Newborn; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D008133:Long QT Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D011412:Propanolamines / Q000008:administration & dosage; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D000098850:Polymorphic Catecholaminergic Ventricular Tachycardia
D000779:Anesthetics, Local; D000889:Anti-Arrhythmia Agents; D011412:Propanolamines; D008012:Lidocaine; C036604:esmolol; D000638:Amiodarone