Perimortem cesarean section in a pregnant woman with flecainide-induced ventricular tachycardia: A case report

Lee, Jae Young; Song, Eun; Suh, Jeong Hun; Choi, Woo Jong; Cho, Sung Kang; Han, Sung Min

Case Report

Obstetric Anesthesia

Anesthesia and Pain Medicine 2012;7(1):76-79.
Published online January 31, 2012.

Perimortem cesarean section in a pregnant woman with flecainide-induced ventricular tachycardia: A case report

Jae Young Lee, Eun Song, Jeong Hun Suh, Woo Jong Choi, Sung Kang Cho, Sung Min Han

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. azac2000@naver.com

Abstract

Flecainide is a drug used to manage supraventricular and ventricular arrhythmias. It is also effective in the treatment of fetal tachyarrhythmia through administration to the mother. However, flecainide toxicity may cause serious complications, including cardiac conduction disturbance, ventricular arrhythmia, resulting in syncope and sudden death. We describe here a 27-year-old woman at 31 weeks of gestation who experienced ventricular tachycardia, leading a perimortem cesarean section. On her past medication history, she has taken overdose of oral flecainide for the treatment of fetal atrial flutter. Just after neonatal delivery, her ventricular tachycardia was successfully reverted to a sinus rhythm through administration of intravenous lidocaine and hemodynamics were stabilized. According to her clinical signs and symptoms, we presume the ventricular tachycardia was likely induced by flecainide toxicity, although serum flecainide concentration could not be measured in our institution.

Key Words: Fetal atrial flutter, Flecainide, Perimortem cesarean section, Ventricular tachycardia