Anesthesia for a Patient with Catecholaminergic Polymorphic Ventricular Tachycardia

Abstract

A patient with catecholaminergic polymorphic ventricular tachycardia required anesthesia for implantation of a defibrillator. The diagnostic criteria, treatment, and anesthetic considerations for this rare, familial dysrhythmia are described.

Anesthetic management for inhibiting sympathetic activation in an adolescent patient diagnosed with catecholaminergic polymorphic ventricular tachycardia and undergoing left cardiac sympathetic denervation: A case report

“… 6 Therefore, methods are needed to blunt the effect of catecholamines. Guidelines for treating patients with CPVT recommend various therapeutic options, 7 , 8 and patients diagnosed with CPVT require lifestyle changes that limit or avoid competitive sports or stressful environments. 7 , 8 In addition, beta‐adrenergic receptor blockers (BB) are recommended as the primary treatment for all symptomatic patients, and adding flecainide, a sodium‐channel blocker, to BB may be useful.…”

“…Guidelines for treating patients with CPVT recommend various therapeutic options, 7 , 8 and patients diagnosed with CPVT require lifestyle changes that limit or avoid competitive sports or stressful environments. 7 , 8 In addition, beta‐adrenergic receptor blockers (BB) are recommended as the primary treatment for all symptomatic patients, and adding flecainide, a sodium‐channel blocker, to BB may be useful. 7 The guideline recommends LCSD if patients are intolerant to or have a contraindication to this first‐line BB medication and if recurrent syncope or VT or several implantable cardioverter defibrillator (ICD) shocks occur, despite continued medication.…”

“…Thoracic epidural analgesia (TEA) has been reported to be effective in patients with ventricular arrhythmia, including in patients with CPVT undergoing LCSD. 8 , 24 Both pain relief and sympathetic block effects can be obtained by injecting local anesthetics or opioids into the epidural space from T1 to T4. TEA is also beneficial in reducing postoperative arrhythmia, especially in cardiac surgery.…”

“…In addition to minimizing a patient's sympathetic response to external stimuli, clinicians should pay attention to avoiding drugs with intrinsic sympathomimetic activity that act on beta‐adrenergic receptors among the medications commonly used by anesthesiologists. 2 , 8 Most anesthetics are safe for use 8 , 36 , 37 ; however, ketamine should be avoided because of its sympathomimetic properties. 2 , 38 In addition, among volatile agents, if the concentration of desflurane is rapidly increased, then sympathetic activation and an increase in catecholamine plasma concentration can be induced.…”

Cardiac Arrest From Undiagnosed Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report

“…During the post-cardiac arrest care of CPVT patients, the administration of β-adrenergic agonists should still be avoided [ 10 ]. Vasopressors with pure α-adrenergic activity, such as phenylephrine, are safer for the treatment of hypotension in these patients [ 10 ].…”