12//02/26 morning, greeted by my colleague who was stressing out the whole night because of one maternal case, 25 year old Myanmar lady, referred from private hospital, who developed extreme narrow complex tachycardia 4 hours post spontaneous vaginal delivery at private hospital. Multiple treatments given, including IV Adenosine, Cardioversion multiple times, IV Digoxin loading doses, IV Verapamil, the heart still beating like nobody business at the rate of 200bpm. Blood pressure was also fluctuating and patient needed to be intubated and sedated to ease further treatments. The only drug that was responsive was Esmolol boluses where the HR down to 140bpm and BP improved to 150/90 with visible diastolic wave seen at arterial line wave.
13/02/26 evening, heart rate still persistently beating at 200bpm. Our center does not have in-house cardiologist and case was discussed with cardiologist from another nearby tertiary hospital. Also, not much respond was observed following cardio's management plan. The only definitive plan was for further cardio TCA once patient can be stabilized and extubated. But, I doubt that time will come if we do not slow down the crazily beating heart.
Met with patient's husband, who she married in 2023, together work in a restaurant since 2023. Husband was very sad after hearing the bad news of patient's condition.
Found few case reports used Ivabradine. I remembered Klang intensivist practices giving Ivabradine for fast atrial fibrillation which was not the indication of Ivabradine. I guess he must have the reason of continue using Ivabradine. Even neonate who had refractory focal atrial tachycardia treated with Ivabradine, avoided radiofrequency ablation.
Hope we can get Ivabradine and administer it to this Myanmar lady, who has a baby waiting for her. We are out of treatment alternative. Sad case......
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Report of a patient with refractory atrial tachycardia whose heart rate was controlled using ivabradine . https://pmc.ncbi.nlm.nih.gov/articles/PMC8918960/
Use of ivabradine in supraventricular tachycardia caused by refractory focal atrial tachycardia in neonates to avoid radiofrequency ablation. https://mansapublishers.com/ijch/article/view/1861/1467
Refractory Atrial Tachycardia and Ivabradine in a Case of Catecholaminergic Polymorphic Ventricular Tachycardia. https://www.authorea.com/users/871783/articles/1252596-refractory-atrial-tachycardia-and-ivabradine-in-a-case-of-catecholaminergic-polymorphic-ventricular-tachycardia
