J Pediatr Intensive Care 2022; 11(01): 072-076
DOI: 10.1055/s-0040-1715851
Case Report

Development of Antiarrhythmic Therapy-Resistant Ventricular Tachycardia, Ventricular Fibrillation, and Premature Ventricular Contractions in a 15-Year-Old Patient

1   Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
2   Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
3   Department of Pediatric Neurology, Bezmialem Vakif University, Istanbul, Turkey
4   Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
4   Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
5   Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
Gokce Ergun
5   Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
Nur Tekin
5   Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
6   Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
› Author Affiliations
Funding None.


Sudden cardiac arrest (SCA) is the sudden cessation of regular cardiac activity so that the victim becomes unresponsive, with no signs of circulation and no normal breathing. Asystole, ventricular tachycardia (VT), ventricular fibrillation (VF), and pulseless electrical activity are the underlying rhythm disturbances in the pediatric age group. If appropriate interventions (cardiopulmonary resuscitation-CPR and/or defibrillation or cardioversion) are not performed rapidly, this condition progresses to sudden death. There have not been many reported cases of the approach and treatment of cardiac arrhythmias after SCA. Herein, we would like to report a case of a 15-year-old female patient with dilated cardiomyopathy (DCM) who was admitted to our clinic a year ago, and while her left ventricular systolic functions were improved, SCA suddenly occurred. Since the SCA event occurred in another city, intravenous treatment of amiodarone was done immediately and was switch to continuous infusion dose of amiodarone until the patient arrived at our institution's pediatric intensive care unit (PICU) 3 hours later. During the patient's 20-day PICU hospitalization, she developed pulseless VT and VF from time to time. The patient's pulseless VT and VF attacks were brought under control by the use of a defibrillator and added antiarrhythmic drugs (amiodarone, flecainide, esmolol, and propafenone). Intriguingly, therapy-resistance bigeminy with premature ventricular contractions (PVCs) continued despite all these treatments. The patient did not have adequate blood pressure measured by invasive arterial blood pressure monitoring while having bigeminy PVCs. The intermittent bigeminy PVCs ameliorated rapidly after intermittent boluses of lidocaine. In the end, multiple antiarrhythmic therapies and intermittent bolus lidocaine doses were enough to bring her cardiac arrhythmias after SCA under control. This case illustrates that malign PVC's should be taken very seriously, since they may predispose to the development of VT or VF. Also, this case highlights the importance of close vigilance of arterial pressure tracings of patients with bigeminy PVCs which develop after SCA and should not be accepted as normal.

Authors' Contributions

All authors participated in creating content for the manuscript, editing, and provided final approval for submission. No undisclosed authors contributed to the manuscript.

Publication History

Received: 09 May 2020

Accepted: 04 July 2020

Article published online:
28 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Buxton AE, Calkins H, Callans DJ. et al. ACC/AHA/HRS 2006 key data elements and definitions for electrophysiological studies and procedures: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to Develop Data Standards on Electrophysiology). Circulation 2006; 114 (23) 2534-2570
  • 2 Thiene G. Sudden cardiac death and cardiovascular pathology: from anatomic theater to double helix. Am J Cardiol 2014; 114 (12) 1930-1936
  • 3 Fabre A, Sheppard MN. Sudden adult death syndrome and other non-ischaemic causes of sudden cardiac death. Heart 2006; 92 (03) 316-320
  • 4 Zorzi A, Pelliccia A, Corrado D. Inherited cardiomyopathies and sports participation. Neth Heart J 2018; 26 (03) 154-165
  • 5 Pelliccia A, Solberg EE, Papadakis M. et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2019; 40 (01) 19-33
  • 6 Zipes DP. Epidemiology and mechanisms of sudden cardiac death. Can J Cardiol 2005; 21 (suppl A): 37A-40A
  • 7 Maisch B, Pankuweit S. Standard and etiology-directed evidence-based therapies in myocarditis: state of the art and future perspectives. Heart Fail Rev 2013; 18 (06) 761-795
  • 8 Dimas VV, Denfield SW, Friedman RA. et al. Frequency of cardiac death in children with idiopathic dilated cardiomyopathy. Am J Cardiol 2009; 104 (11) 1574-1577
  • 9 Abd El Mohsen AM, Antonios MA, Elbiomy MM. Incidence of cardiac arrhythmia in children with dilated cardiomyopathy. Alex J Pediatrics 2017; 30: 32-36
  • 10 Zorzi A, Gasparetto N, Stella F, Bortoluzzi A, Cacciavillani L, Basso C. Surviving out-of-hospital cardiac arrest: just a matter of defibrillators?. J Cardiovasc Med (Hagerstown) 2014; 15 (08) 616-623
  • 11 Banna M, Indik JH. Risk stratification and prevention of sudden death in patients with heart failure. Curr Treat Options Cardiovasc Med 2011; 13 (06) 517-527
  • 12 Kindermann I, Barth C, Mahfoud F. et al. Update on myocarditis. J Am Coll Cardiol 2012; 59 (09) 779-792
  • 13 D'Ambrosio A, Patti G, Manzoli A. et al. The fate of acute myocarditis between spontaneous improvement and evolution to dilated cardiomyopathy: a review. Heart 2001; 85 (05) 499-504
  • 14 Erath JW, Hohnloser SH. Drugs to prevent sudden cardiac death. Int J Cardiol 2017; 237: 22-24
  • 15 Mark JB, Slaughter TF, Reves JG. Cardiovascular monitoring. In: Miller RD. ed. Anesthesia, 5th ed. vol. 1. New York, NY: Churchill Livingstone; 2000: 1131-1142
  • 16 Lake CL. Monitoring of arterial pressure. In: Lake CL. , ed. Clinical Monitoring for Anesthesia and Critical Care, 2nd ed. Philadelphia, PA: WB Saunders; 1994: 115-126
  • 17 Ponikowski P, Voors AA, Anker SD. et al; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37 (27) 2129-2200
  • 18 Blewer AL, Putt ME, Becker LB. et al. CHIP Study Group*. Video-only cardiopulmonary resuscitation education for high-risk families before hospital discharge: a multicenter pragmatic trial. Circ Cardiovasc Qual Outcomes 2016; 9 (06) 740-748
  • 19 Corrado D, Zorzi A, Vanoli E, Gronda E. Current challenges in sudden cardiac death prevention. Heart Fail Rev 2020; 25 (01) 99-106