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• W2078286470 abstract "A previously fit 40-year old female was scheduled for oesophagectomy for carcinoma of the oesophagus. Her general physical examination, routine haematological and biochemical investigations were normal. Twelve lead ECG showed normal sinus rhythm with occasional premature ventricular complexes (PVCs) and a normal QTc interval. She was premedicated with pentazocine 30 mg and atropine 0.6 mg intramuscularly. Anaesthesia was induced with thiopental 250 mg with succinylcholine 75 mg given to facilitate tracheal intubation. Anaesthesia was maintained with isoflurane 0.5–1.0% and nitrous oxide 60% in oxygen. Neuromuscular blockade was achieved with pancuronium bromide. While being turned to the lateral decubitus position for thoracotomy, she developed ventricular tachycardia. She was immediately returned to the supine position. Surgery was abandoned for further cardiac evaluation, as she had recurrent episodes of ventricular tachycardia. Her echocardiography showed normal valvular sizes and function. Dobutamine stress echocardiography was normal. Holter monitoring showed heart rate variations between 58 and 196.min−1 with an average of 97.min−1. The 24 h record also revealed multiple runs of ventricular tachycardia with a total load of 1478 PVCs and 19 short episodes of ventricular tachycardia (VT), one lasting 11 beats. To confirm the postural relationship, she was turned repeatedly to each lateral side in an attempt to reproduce the ventricular tachycardia. Ventricular tachycardia was reproducible most times on change of posture, and was sustained for 2–3 min in each episode, with few intervening normal complexes. However, haemodynamics remained stable throughout. She was again scheduled for surgery for completion of oesophagectomy after 5 days. As she was asymptomatic, no anti arrhythmic drug was given in the peri-operative period. General anaesthesia was conducted with the same protocol as used previously. Monitoring included continuous ECG, SpO2, non-invasive blood pressure, CVP and urine output. Surgery was completed successfully in 7 h. Although the ECG trace showed multiple runs of ventricular tachycardia during the course of surgery, her haemodynamics remained stable throughout. Ventricular tachycardia is a serious arrhythmia because of its potential to degenerate into more malignant arrhythmias with catastrophic collapse. It is often caused by underlying ischaemic heart disease or other organic cardiac pathologies such as cardiomyopathy, cardiac tumours, prolonged QT syndrome, electrolyte disturbances and pheochromocytoma [1, 2]. Rarely, it may present as recurrent benign episodes. Lu and coworkers found females to be more prone to ventricular arrhythmias [3]. Recently, the benign nature of this arrhythmia has been questioned [4]. The management of cases with asymptomatic ventricular tachycardia is controversial. It becomes even more of a dilemma when such cases are subjected to anaesthesia and surgical stress. The risk-benefit ratio of treating each specific type of VT has to be considered before beginning therapy, as anti arrhythmic drugs also have pro-arrhythmic effects and can even worsen the stable ventricular rhythms. Our patient had recurrent asymptomatic ventricular tachycardia, which was associated with change of posture. Although position related paroxysmal supraventricular tachycardias (PSVTs) are well known in patients with mitral valve prolapse [5] and autonomic neuropathies, positional recurrent ventricular tachycardia is unknown. It is difficult to postulate an explanation and a correlation with carcinoma of the oesophagus, as there was no direct tumour invasion of the pericardium. We suggest that anti arrhythmic therapy can be avoided unless patients with these arrhythmias show haemodynamic instability. Prophylactic anti arrhythmic therapy should be reserved where minor haemodynamic fluctuations for a brief period may be disastrous, such as transplant and microvascular surgery." @default.
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• W2078286470 date "2003-01-01" @default.
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• W2078286470 title "Recurrent positional ventricular tachycardia in a patient with carcinoma of the oesophagus" @default.
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• W2078286470 doi "https://doi.org/10.1046/j.1365-2044.2003.296819.x" @default.
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