Introduction: Ventricular tachycardia (VT) is a life-threatening cardiac arrhythmia. Emergent management strategies such as intravenous antiarrhythmics, AV nodal blockers, and electrical cardioversion can effectively terminate VT. However, some cases persist despite these strategies. Some evidence suggests the use of sympathetic blockade in these cases. The effects of Propofol on cardiac arrhythmias is not well documented. We present the case of a 71 year old male successfully treated for VT storm with Propofol, after other agents and cardioversion failed to terminate the VT.
Description: The patient was a 71 year old male with a history of HFrEF and hereditary prolonged QT syndrome with AICD. He was referred to the emergency department by his nephrologist for worsening renal failure. He was admitted to the medical floor where his course was complicated by bouts of supraventricular tachycardia and worsening heart failure.
On hospital day seven, he developed VT storm and was electrically cardioverted by the AICD over thirty-five times in a span of six hours. During this time span, the ICU team administered intravenous amiodarone, lidocaine and metoprolol without significant response. Eventually the decision was made to treat the VT with Propofol. The VT storm resolved minutes after the Propofol infusion was initiated. The patient was then transferred to a tertiary heart failure center where he underwent left ventricular assist device placement.
Discussion: Emergent management for VT includes antiarrhythmics, atrioventricular nodal blockers and electrical cardioversion. Propofol is a general anesthetic widely used for anesthesia and sedation. It causes global CNS depression most likely through GABA agonism and NMDA receptor blockade. Propofol is known to promote bradycardia and hypotension and may interfere with the cardiac conduction system, though it is unclear whether this is by direct electrophysiological effects or changes in the autonomic nervous system.
There have been case reports on the use of Propofol in supraventricular arrhythmias and ventricular arrhythmias. Our case corroborates previous reports of Propofol’s potential use in management of refractory VT storm. Clinicians should be aware of this potential management strategy when treating ventricular tachycardias.
