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213: ISOPROTERENOL AND LIDOCAINE FOR RECURRENT TORSADES DE POINTES IN A 32-YEAR-OLD PREGNANT WOMAN

Introduction: Guidelines recommend magnesium and defibrillation for torsades de pointes (TdP) treatment in pregnancy, both of which were unsuccessful at terminating our 32 year old pregnant patient’s recurrent ventricular arrhythmias. Both lidocaine and isoproterenol carry potential risks to mother and fetus but the risk of congenital abnormalities is significantly lower compared to other antiarrhythmics such as amiodarone. Description: A 15-week pregnant 32 year old female was admitted to an outside hospital for alcohol withdrawal. The next morning she had a single episode of ventricular tachycardia (VT) accompanied by syncope and later developed pulseless VT for which she received 5 minutes of cardiopulmonary resuscitation (CPR), 1 mg of epinephrine, and a single defibrillation before she regained spontaneous circulation. Hours later she had another episode of VT/TdP which resolved with administration of magnesium and she was promptly transferred to our hospital for escalation of care. On arrival she was awake, alert, and hemodynamically stable. Shortly after admission to the intensive care unit the patient began experiencing recurrent episodes of TdP that developed into pulseless VT despite defibrillation, magnesium and calcium administration, and chest compressions. We initiated lidocaine and isoproterenol infusions, after which the patient stabilized and the episodes did not recur. Isoproterenol and lidocaine were successfully discontinued after 2 days of treatment and the patient was discharged after 4 days of hospitalization with fetal heart sounds intact. Discussion: While there are guideline recommendations for the management of TdP and ventricular arrhythmias, there is a lack of primary literature. An extensive literature search revealed only a few case reports of lidocaine and isoproterenol being used together for patients experiencing TdP, and only a single case report regarding the use of isoproterenol for TdP in a pregnant female. This unique case of torsades de pointes and recurrent VT arrests in a pregnant 32 year old female demonstrates efficacy of isoproterenol pacing combined with the antiarrhythmic lidocaine for terminating a refractory and life-threatening ventricular arrhythmia.