Successful management of near-incessant bidirectional ventricular tachycardia in one-year-old child with COVID-19 infection: a case report

Background: The COVID-19 is an infectious disease, caused by SARS-CoV-2 virus. Cardiovascular complications of COVID-19 are reported more often, from inflammatory cardiac diseases to acute coronary syndromes, thromboembolic events and arrhythmias. Sometimes, these arrhythmias may be life threatening and require urgent intervention. Case summary: This is a case of one-year-old boy, who was referred to our hospital because of premature ventricular complexes on ECG. The child had genetic chimerism with a karyotype of 46XY(12)/46XX(3) and small patent ductus arteriosus. We observed non-sustained episodes of bidirectional ventricular tachycardia (VT) on 24 h Holter monitor, which increased over time and caused multiple planned and urgent shocks, despite antiarrhythmic drugs and deep sedation and intubation. Patient was tested positive for COVID-19 using PCR. After thorough echocardiographic testing and a negative genetic analysis for arrhythmogenic disorders he was diagnosed with COVID-19 associated ventricular tachycardia, taking into account that he also developed multisystem inflammatory syndrome. Further, a significant decrease of ventricular activity was observed, which allowed us to implant a cardioverter-defibrillator (ICD). Soon after the implantation the storm of ventricular tachycardia restarted with multiple shocks of the device. This time left partial thoracic sympathectomy was performed and the patient didn't have ICD shocks any more. Discussion: COVID-19 infection can be associated with significant arrhythmias, including fatal ventricular arrhythmias also in children. Left partial thoracic sympathectomy can be a helpful option in patients with sustained ventricular tachycardia and multiple ICD shocks, in whom antiarrhythmic treatment or VT ablation is useless or not available.