Intra-Operative Lidocaine Management in the Setting of Ventricular Tachycardia Storm: A Case Report

Ventricular tachycardia (VT) is an abnormal heart rhythm associated with significant morbidity and mortality.Our case involves a patient with a history of VT that had been treated with two ablations, pharmacologic management and an ICD.He presented in VT storm that was controlled during his hospital admission with a lidocaine infusion.In the electrophysiology laboratory, cardiac mapping was initially performed during sinus rhythm.A dopamine infusion was initiated to maintain hemodynamic stability.The lidocaine infusion was then discontinued, and VT was induced.Cardiac mapping was performed in sinus rhythm and in VT to evaluate the critical isthmus responsible for VT propagation as a target for ablation.Patient remained VT free following VT ablation without the need for antiarrhythmic drug therapy at 6 months. Key Clinical MessageTailored management of intraoperative lidocaine infusion discontinuation can facilitate VT induction despite the half-life of 1-2 hours, contrary to common perception, such a short lidocaine free period renders VT to be non-inducible.In this case, VT was readily inducible despite the fact that lidocaine remains to be given until cardiac mapping was performed.