Reachi B, Negrelli J, Hickman A, Beesley S, Osborn J (2019) Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-year-old Pregnant Woman. Int J Crit Care Emerg Med 5:092.


© 2019 Reachi B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

CASE REPORT | OPEN ACCESSDOI: 10.23937/2474-3674/1510092

Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-year-old Pregnant Woman

Breyanna Reachi, PharmD1*, Jenna Negrelli, PharmD2, Abby Hickman, PharmD, MBA, BCCCP1, Sarah Beesley, MD3 and Jeffrey Osborn, MD4

1Department of Pharmacy, Intermountain Medical Center, USA

2Department of Pharmacy, Loyola University Medical Center, USA

3Department of Critical Care, Intermountain Medical Center, USA

4Department of Electrophysiology, Intermountain Medical Center, USA


Guidelines recommend magnesium and defibrillation for Torsades de Pointes (TdP) treatment in pregnancy, both of which were unsuccessful at terminating our patient's recurrent ventricular arrhythmias. Both lidocaine and isoproterenol carry potential risks to mother and fetus, but the risk of congenital abnormalities is significantly lower compared to other antiarrhythmics such as amiodarone.

A 15-week pregnant 32-year-old female was admitted to an outside hospital for alcohol withdrawal and developed multiple episodes of ventricular tachycardia (VT) and TdP resulting in her prompt transfer to our hospital for escalation of care. On arrival she was awake, alert, and hemodynamically stable but quickly began experiencing recurrent episodes of TdP that developed into pulseless VT despite defibrillation, magnesium and calcium administration, and chest compressions. We initiated lidocaine and isoproterenol infusions, after which the patient stabilized. Isoproterenol and lidocaine were successfully discontinued after 2 days of treatment and the patient was discharged after 4 days of hospitalization with fetal heart sounds intact.

While there are guideline recommendations for the management of TdP and ventricular arrhythmias, primary literature is lacking. This unique case demonstrates efficacy of isoproterenol pacing combined with the antiarrhythmic lidocaine for terminating a refractory and life-threatening ventricular arrhythmia.