Case 17: A 8-Month-Old Girl with Recurrent Episodes of Fascicular Ventricular Tachycardia

A 2-month-old girl experienced multiple episodes of large QRS tachycardia unresponsive to intravenous Amiodarone in a dose ranging from 5 to 20 mg/kg/24 h. The patient received repeated boluses of 300 μg/kg of adenosine, 10 μg/kg/24 h of Digoxin intravenously, a progressive dose of Propranolol from 1 mg/kg to 4 mg/kg/24 h, and initially 1 mg/kg of Flecainide, which was gradually increased to 3 mg/kg/24 h without affecting the frequency of arrhythmia episodes. Due to morphology of the tachycardia, fascicular ventricular tachycardia was suspected and Verapamil was administered at a dose of 0.2 mg/kg despite its relative contraindication in children under 12 months due to the danger of cardiac collapse. No response was observed to Verapamil. Only Lidocaine at a dose of 1 mg/kg effectively treated the tachycardia, but the girl needed multiple doses throughout the day. After receiving five doses, she had Lidocaine-induced convulsions. She experienced multiple hospital stays until she was 8 months old, at which point she was transferred to Barcelona and radiofrequency catheter ablation of fascicular VT was performed (Figs. 23.1, 23.2, 23.3, 23.4, 23.5, 23.6, 23.7, 23.8, 23.9, 23.10, and 23.11).