Key result
Multimodal pharmacotherapy including lidocaine for refractory ventricular tachycardia in a neonate with Long QT syndrome resulted in presumed lidocaine neurotoxicity despite normal serum levels.
Case Report (n=1)
Highlights the challenges and potential for complex pharmacokinetic interactions leading to lidocaine neurotoxicity in neonates with Long QT syndrome treated with multimodal pharmacotherapy.
Lidocaine requires caution in neonates with Long QT syndrome on multimodal therapy despite normal levels; case report leaves open pharmacokinetic interactions.
Long QT syndrome is characterized by electrocardiographic appearance of long QT intervals and propensity to polymorphic ventricular tachycardia. Aggressive anticipatory clinical management is required for a good outcome, especially in the symptomatic neonate. We present a neonate with a compound mutation with refractory ventricular tachycardia that necessitated multimodal pharmacotherapy with lidocaine, esmolol, and amiodarone along with ventricular pacing. Despite normal serum lidocaine levels, complex pharmacokinetic interactions resulted in presumed neurotoxicity due to lidocaine. This report discusses the implications and challenges of management of a neonate with compound long mutations.
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Nathan et al. (2012) conducted a case report in Long QT Syndrome, refractory ventricular arrhythmias, lidocaine toxicity (n=1). Multimodal pharmacotherapy (lidocaine, esmolol, amiodarone, ventricular pacing) was evaluated. Multimodal pharmacotherapy including lidocaine for refractory ventricular tachycardia in a neonate with Long QT syndrome resulted in presumed lidocaine neurotoxicity despite normal serum levels.
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