Successful vaginal delivery in a parturient with long QT syndrome type 2 using double-catheter epidural analgesia A CARE-compliant case report

Abstract

Rationale: Congenital long QT syndrome (LQTS) can cause syncope or sudden death due to ventricular arrhythmia. Congenital LQTS has 3 major types, 1, 2, and 3. Life-threatening arrhythmias are triggered by emotion in patients with LQTS type 2. As patients with LQTS type 2 have a higher incidence of postnatal cardiac events, careful perinatal management especially during delivery is required. To the best of our knowledge, perinatal management of a patient with LQTS type 2 has not been properly described with consideration to its type-specific risk factors for ventricular tachyarrhythmia. Patient concerns: A 36-year-old pregnant woman, gravida 1, para 0, with LQTS type 2 was scheduled to undergo vaginal delivery under epidural labor analgesia in the 38th week of pregnancy. No fainting episodes were reported since she began to take 40 mg of propranolol once daily at the age of 25. Despite this, we instituted maximum preventive measures for the safety of both the parturient and the fetus to minimize the risk of maternal cardiac events throughout the perinatal period. Diagnoses: She was diagnosed with LQTS type 2 by genetic testing at the age of 25. Interventions: Two epidural catheters were placed at levels T11–T12 and L5–S1. Injection of 0.2% ropivacaine and subsequent infusion of ropivacaine 0.1% with fentanyl (2 mg/mL) was directed through each catheter according to the stage of labor. Concurrently, landiolol, a selective and short-acting b1 receptor antagonist, was infused intravenously at a dose of 1 to 7 mg/kg/min. Outcomes: The delivery proceeded uneventfully without pain. No adverse cardiac events were observed during the perinatal period. Lessons: Vaginal delivery under epidural labor analgesia using 2 catheters might be a viable option for maternal perinatal care and delivery of patients with LQTS type 2.