Iatrogenic ventricular tachycardia

Aims: Cardiac arrhythmias in children may occur after cardiac surgery. Depending on their etiology and presentation, cardiac arrhythmias may be life-threatening. Prompt diagnosis and initiation of specific therapeutic interventions are mandatory.

Patient and methods: Case report.

Results: A 6-week-old female neonate underwent cardiac surgery for repair of congenital cor triatriatum sinister and atrial septal defect. Following an uneventful surgery with resection of the intra-atrial membrane and closure of the atrial septal defect, two pleural and one mediastinal tubes were inserted. On conventional X-ray it was noted that the mediastinal tube surrounded the heart. When removing the mediastinal catheter on day two post-operatively, some resistance was felt initially, and the girl suddenly developed ventricular tachycardia with cardio-circulatory depression secondary to cardiac compression. The removal of the catheter was stopped, a precordial thump was delivered, and ventricular tachycardia subsided immediately. With a second physician being present to perform cardiac defibrillation if needed, the catheter was then removed very cautiously without recurrence of ventricular tachycardia.

Conclusions: The inadvertent positioning of a substernal catheter surrounding the heart may cause life-threatening cardiac arrhythmias when being removed. The treating physician should be aware of these life-threatening complications, and should be prepared to initiate adequate treatment if necessary.

Literatur: 1. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 12: Pediatric Advanced Life Support. Circulation 2005; 112 Suppl I: IV-156-IV-166 2. Amir O, Schliamser JE, Nemer S, Arie M. Ineffectiveness of precordial thump for cardioversion of malignant ventricular tachyarrhythmias. Pacing Clin Electrophysiol 2007; 30:153-6 3. Beke DM, Braudis NJ, Lincoln P. Management of the pediatric postoperative cardiac surgery patient. Crit Care Nurs Clin North Am 2005; 17:405-416 4. Karpawich PP, Pettersen MD, Gupta P, Shah N. Infants and children with tachycardia: natural history and drug administration. Curr Pharm Des 2008; 14:743-752

Iatrogenic Ventricular tachycardia Cardiac surgery