腹腔鏡下子宮全摘術中および術後に多形性心室頻拍 Torsade de Pointesとなった一例

抄録

Introduction: Long QT syndrome (LQTS) is divided into congenital and acquired LQTS. Acquired LQTS is induced by various factors and may lead to lethal arrhythmias. Some studies report that pneumoperitoneum can prolong the QT interval. A 49-year-old woman underwent total laparoscopic hysterosalpingectomy for myoma with no medical and family history.

  Her preoperative electrocardiography (ECG) was sinus rhythm and showed no abnormalities. When she entered the operating room, the QT interval on the ECG monitor was already prolonged; QTc 500 ms. After pneumoperitoneum, premature ventricular contractions (PVCs) were frequently observed, and QTc became 768 ms. Torsade de Pointes (TdP) occurred at 26, 27, and 71 minutes after beginning the operation, and each of them recovered spontaneously. Postoperative blood reports showed mild hypokalemia, K 3.2 mmol/l. Supplementary potassium was started, and monitoring using ECG was continued.

  After 3 hours, TdP recurred and developed into ventricular fibrillation. It persisted for about 2 minutes and recovered to normal sinus rhythm. At this point, K was 3.5 mmol/l and Mg was 2.0 mg/dl. Further, 20 mg of Mg was administered and a continuous lidocaine infusion was started. QTc on postoperative day (POD) 1 was 413 ms, and 24-hour Holter ECG showed only 2 PVCs and 9 supraventricular premature contractions. TdP did not recur, and she was discharged on POD 6.

Conclusion: In this case, hypokalemia resulted in acquired LQTS, pneumoperitoneum exacerbated it, and RonT premature contractions triggered TdP. More attention should be paid to prevent QTc interval prolongation and TdP during laparoscopic surgery, even when preoperative ECG findings are normal.