title: Verapamil-sensitive idiopathic left ventricular tachycardia in a 6-month-old: unique considerations in diagnosis and management in an infant.
abstract: Idiopathic left ventricular tachycardia of the Belhassen type is rare in infants. We present a 6-month-old infant girl with a wide-complex tachycardia with right bundle branch block QRS morphology, a superior axis, and atrioventricular dissociation, consistent with a left anterior fascicular tachycardia. Initial echocardiogram revealed depressed ventricular function. The tachycardia was unresponsive to therapeutic trials of adenosine, esmolol, procainamide, and lidocaine. There was brief conversion of the tachycardia to sinus rhythm with transesophageal atrial overdrive pacing, suggesting a reentrant mechanism of the arrhythmia. Ultimately, the judicious administration of intravenous verapamil resulted in termination of the arrhythmia, which has been sustained on oral therapy.
authors.affiliation: From the School of Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Gurumurthy
authors.initials: G
authors.lastname: Hiremath
authors.forename: Walter
authors.initials: W
authors.lastname: Li
authors.forename: Rhonda
authors.initials: R
authors.lastname: Foltz
authors.forename: Arup
authors.initials: A
authors.lastname: Roy-Burman
authors.forename: Mark
authors.initials: M
authors.lastname: Cocalis
authors.forename: Ronn E
authors.initials: RE
authors.lastname: Tanel
mesh_terms: D000241:Adenosine / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002037:Bundle-Branch Block / Q000150:complications* / Q000188:drug therapy; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008012:Lidocaine / Q000627:therapeutic use*; D011342:Procainamide / Q000627:therapeutic use*; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014700:Verapamil / Q000627:therapeutic use*
chemical_list: D000889:Anti-Arrhythmia Agents; D008012:Lidocaine; D014700:Verapamil; D000241:Adenosine; D011342:Procainamide