Paroxysmal bidirectional ventricular tachycardia with tachycardiomyopathy in a pregnant woman

• Published in: Acta Cardiologica 2009-06, Vol.64 (3), p.419-422
• Main Authors: Walker, Nicola L., Cobbe, Stuart M., Mcgavigan, Andrew D.
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Anti-Arrhythmia Agents - therapeutic use; bidirectional; Bisoprolol - therapeutic use; Cesarean Section; Female; flecainide; Flecainide - therapeutic use; Humans; Pregnancy; Pregnancy Complications, Cardiovascular - diagnosis; Pregnancy Complications, Cardiovascular - drug therapy; Pregnancy Complications, Cardiovascular - surgery; Pregnancy Outcome; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - drug therapy; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - surgery; tachycardiomyopathy; ventricular tachycardia
• ISSN: 0001-5385; 0373-7934; 0001-5385
• DOI: 10.2143/AC.64.3.2038033

Palpitations in pregnancy are not an uncommon complaint.We present a case of palpitations in the third trimester related to bidirectional ventricular tachycardia with evidence of left ventricular systolic dysfunction. The case was successfully managed with flecainide therapy and urgent elective caesarean section. The rhythm stabilised to sinus rhythm and left ventricular systolic function normalised. We discuss the possible underlying diagnosis of catecholaminergic polymorphic ventricular tachycardia with resultant tachycardiomyopathy. A literature review of bidirectional ventricular tachycardia is presented. This is the first reported case of bidirectional VT producing LV systolic dysfunction, which normalised following stabilisation of rhythm.The complex issues of management of this case in particular with regard to the pregnancy are discussed.