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Propofol for electrical storm; a case report of cardioversion and suppression of ventricular tachycardia by propofol

[Le propofol et la tempête électrique; l’observation d’un cas de cardioversion et de suppression de la tachycardie ventriculaire par le propofol]

From the Department of Anaesthesiology, Queen’s University, Kingston, Ontario, Canada.

Address correspondence to: Dr. Brian Milne, Department of Anaesthesiology, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada. Phone: 613-548-3232 ext. 7827; E-mail: milneb{at}post.queensu.ca

Purpose: To present a case report where propofol abolished recurrent ventricular tachycardia (VT) and to suggest a mechanism by which this may have occurred.

Clinical features: A 65-yr-old male was admitted to the intensive care unit (ICU) with electrical storm. Recurrent episodes of VT persisted despite maximal anti-arrhythmic therapy and resulted in a prolonged ICU course and the need for intra-aortic balloon pump support. This was complicated by an ischemic limb, necessitating an anesthetic for femoral thrombectomy. On several occasions while in the ICU, episodes of VT had resolved with boluses of propofol prior to planned cardioversion. In the operating room, episodes of non-sustained VT resolved after a bolus of propofol and remained suppressed for the duration of the case with the use of a propofol infusion.

Conclusion: The effects of propofol on cardiac conduction and on the autonomic nervous system have been studied but its effects on arrhythmias are not well documented. In this case report, propofol was associated with the resolution and suppression of VT. Recent evidence suggests that sympathetic blockade may be an effective treatment for electrical storm. This may be the mechanism by which propofol can abolish this arrhythmia intraoperatively.

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