Torsade de pointes ventricular tachycardia in a newborn infant.

Abstract

suMMARY A case of paroxysmal ventricular tachycardia of torsade de pointes variety occurring in a newborn infant is described. A rare problem in the newborn, ventricular tachycardia has been associated with congenital heart disease, electrolyte abnormality, and cardiac tumour. In this case, the association was with myocarditis. The arrhythmia was refractory to treatment, and the infant died.Ventricular tachycardia is unusual in children and even rarer in neonates (Addy and Littlewood, 1969;DeGuzman and Silver, 1970;Eibschitz et al., 1975;Hernandez et al., 1975). Torsade de pointes, a variant of ventricular tachycardia, is also rare. It is recognisable by a regularly changing axis in the ventricular complexes of the electrocardiogram (Krikler and Curry, 1976). We present here a case of paroxysmal ventricular tachycardia of torsade de pointes variety, which occurred in a newborn infant with myocarditis and caused a rare and difficult management problem. We are not aware of a report of a similar case. Case report A male infant was born of a 21-year-old primigravida after a normal pregnancy and with no exposure to known teratogens. Labour, which was induced at term by rupture of membranes, lasted 9 hours. Fetal heart rate was normal during labour. Birthweight was 341 kg, height 45 cm, and head circumference 35 cm. The infant appeared well at birth and had normal Apgar scores. About 4 hours later, he was noted to have an irregular heart rate and appeared dusky after a feeding. Signs of respiratory distress and a very abnormal electrocardiogram prompted transfer to The Hospital for Sick Children.On arrival here, at 6 hours of age, the infant was acyanotic, but lethargic. The pulse was irregular, and its rate varied from 50 to 200/min; the respiratory rate was 62/min, temperature was 37°C, blood pressure was 64 mmHg in both arms and 72 mmHg in both legs. Pulses were strong in all limbs except during tachycardia. The chest was clear and heart sounds were normal. A soft systolic ejection murmur was heard over the left sternal border. There was no cranial bruit. The liver edge was palpated 1 cm below the right costal margin.A radiograph showed distinct enlargement of the heart, normal pulmonary vascularity, and a left aortic arch. The electrocardiogram showed complete heart block with ventricular ectopic beats giving rise to paroxysms of ventricular tachycardia (Fig. 1, 2, and 3

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