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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2003  |  Volume : 14  |  Issue : 1  |  Page : 75-76
Recurrent Ventricular Tachycardia-in Patients for Kidney Transplant


Dayanand Medical College and Hospital, 61, Ashok Vihar, Rishi Nagar, Ludhiana - 141001, Punjab, India

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How to cite this article:
Gautam PL, Kathuria S, Kaul TK, Wander GS. Recurrent Ventricular Tachycardia-in Patients for Kidney Transplant. Saudi J Kidney Dis Transpl 2003;14:75-6

How to cite this URL:
Gautam PL, Kathuria S, Kaul TK, Wander GS. Recurrent Ventricular Tachycardia-in Patients for Kidney Transplant. Saudi J Kidney Dis Transpl [serial online] 2003 [cited 2020 Dec 2];14:75-6. Available from: https://www.sjkdt.org/text.asp?2003/14/1/75/33092
To the Editor:

Ventricular tachycardia (VT) is a serious arrhythmia because of its potential for catastrophic collapse. VT is often caused by underlying cardiac disease precipitated by electrolyte disturbances, high catecholamines, and other metabolic disorders. [1],[2] Anesthesio­logists often encounter ventricular arrhythmias perioperatively in routine practice. [3] However, it is rare to have patients with benign recurrent, sustained or nonsustained, ventricular tachycardia planned for non-cardiac surgery. The risk-benefit ratio of treating each specific type of VT has to be considered because antiarrhythmic drugs do have pro-arrhythmic adverse effects and can worsen the stable ventricular arrhythmias.

In general, patients without organic disease have a benign course and need no treatment. However, the very benign nature and course in these patients has been questioned recently and the use of implantable cardioverter­defibrillator was recommended even in asymptomatic patients. [4] Patients with sympto­matic VT usually require treatment. They usually respond to beta-blockers, class 1A, 1C or class 3 agents, or cardioversion.

Patients presenting for non-cardiac surgery with VT may be at increased risk for cardiac complications even if they are asymptomatic.

The literature is not clear about the appropriate management in such cases. We had an experience of a case of a 35 year-old man who was contemplated for renal transplan­tation and was found to have VT just before starting the operation. The patient had been on hemodialysis twice a week for two years prior to surgery. He was on amlodipine, atenolol and prazocin for control of blood pressure. On the day of surgery, his serum sodium was 134 mmol/L, potassium 4.5 mmol/L and creatinine 737 µmol/L. The electro­cardiogram (ECG) showed left ventricular hypertrophy with occasional supraventricular and ventricular ectopics. Echocardiography showed enlarged left atrium (41 mm), mildly thickened chambers, mild mitral and aortic regurgitation with good left ventricular ejection fraction of 76%, but there was a diastolic dysfunction. Epidural anesthesia was attempted with Xylocaine 2%. However, after 30 minutes of blockade, he developed wide complex tachycardia. Injection of amiodarone resulted in restoration of sinus rhythm.

The patient was continued on infusion of amiodarone and the operation was postponed for further cardiac evaluation. Holter monitoring performed after 24 hours of amiodarone infusion revealed frequent runs of ventricular pre­mature contractions (VPCs), 329 pairs of couplets and 182 prolonged runs of VT. The patient was switched to oral amiodarone and Holter monitoring was repeated after a week and showed occasional VPCs, without any couplets or VT runs. Surgery was conducted successfully under general anesthesia, without any hemodynamic fluctuations. The amio­darone was discontinued postoperatively. The patient had an uneventful stay in hospital and was discharged after ten days. Follow­up for a year was also uneventful.

We believe that the amiodarone admini­stration in the operating room helped to control the acute episode of VT but failed to prevent recurrence as revealed by ambulatory ECG monitoring. However, therapy for a week with this drug had a remarkable effect. We also believe that the patients with ventricular arrhythmias should be assessed and managed individually, with a battery of tests to find possibly treatable causes. Serum electrolytes, acid base status, ECG, Holter monitoring, stress testing and catecholamine levels should be performed. Surgery can be performed safely in these patients with close and vigilant hemodynamic monitoring.

 
   References Top

1.Braunwald E. Disorders of the cardiovascular system. In: Fauci AS, Braunwald E, Isselbacher KJ, et al (eds). Harrison's Principles of Internal Medicine. 14 th edition, International edition. McGraw-Hill 1998;1272-3.  Back to cited text no. 1    
2.Petit T, de Lagausie P, Maintenant J, Magnier S, Nivoche Y, Aigrain Y. Thoracic pheochromocytoma revealed by ventricular tachycardia. Clinical case and review of the literature. Eur J Pediatr Surg 2000; 10(2):142-4.  Back to cited text no. 2    
3.O'Kelly B, Browner WS, Massie B, Tuban J, Ngo L, Mangano DT. Ventricular arrhythmias in patients undergoing non-cardiac surgery. JAMA 1992;268:217-21.  Back to cited text no. 3    
4.Raitt MH, Renfroe EG, Epstein AE, et al. "Stable" ventricular tachycardia is not a benign rhythm: insights from the antiarrhythmics versus implan-table defibrillators (AVID) registry. Circulation 2001;103(2):244-52.  Back to cited text no. 4    

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Correspondence Address:
Parshotam Lal Gautam
Dayanand Medical College and Hospital, 61, Ashok Vihar, Rishi Nagar, Ludhiana - 141001, Punjab
India
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PMID: 17657094

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