Left posterior fascicular ventricular tachycardia is a rare type of idiopathic ventricular arrhythmia that mainly occurs in males aged 20–40 years in the absence of structural heart disease. Its occurrence in the paediatric population is rare, and extremely uncommon in neonates. Furthermore, it is a verapamil-sensitive tachycardia, a drug that is contraindicated in the neonatal population. We present the case of a newborn with sustained posterior fascicular VT associated with a bicuspid aortic valve with severe stenosis. With this case, we present the only report in the literature of the use of verapamil in a newborn with underlying structural heart disease for the treatment of incessant ventricular tachycardia.
A 24-hour-old newborn in whom sustained tachycardia was accidentally detected during a routine check-up. The ECG revealed a wide QRS tachycardia with right bundle branch block and superior axis morphology, haemodynamic stable. Vagal manoeuvres were attempted without success, so adenosine was administered in increasing doses, achieving cessation of the tachycardia. TTE was performed, revealing a bicuspid aortic valve with severe stenosis. The tachycardia recurred so reversal with adenosine, Flecainide infusion and synchronised cardioversion was attempted, without success. Finally, it was decided to start intravenous verapamil in a diluted and slow administration, achieving successful reversal to sinus rhythm after 25 minutes of infusion. An aortic valvuloplasty was performed, achieving a decrease in the transaortic gradient and no residual aortic insufficiency. Finally, the patient was discharged home without pharmacological treatment, and no new episodes of tachycardia were observed during follow-up.
Left posterior ventricular tachycardia is an extremely rare arrhythmia in neonates, with fewer than 10 cases published in the literature. Furthermore, it is a condition associated with the absence of structural heart disease. In the case we present, the treatment for this condition has two contraindications for its use: on the one hand, age, as verapamil is relatively contraindicated in children under one year of age, and on the other hand, the presence of underlying heart disease.
However, given the refractoriness of the symptoms and under close surveillance, we demonstrate in this case that non- dihydropyridine calcium antagonists can be used in neonates with structural heart disease and incessant fascicular ventricular tachycardia.