Refractory ventricular tachycardia storm associated with severe hypokalemia in Fanconi syndrome

Rodriguez, Alex P.; Badiye, Amit; Lambrakos, Litsa K.; Ghodsizad, Ali; Myerburg, Robert J.; Goldberger, Jeffrey J.

Intravenous amiodarone and lidocaine loads and maintenance infusions, intravenous potassium, magnesium, calcium, beta blockers (propranolol), isoproterenol infusion, sedation with benzodiazepines and maintenance propofol drip, and rapid ventricular pacing at 130 beats per minute were used to stabilize the arrhythmias, which only improved transiently. Despite aggressive intravenous repletion of potassium (150 mEq), the serum K 1 levels continued to drop to a nadir of 1.7 from the initial value of 2.5. When the arrhythmia burden changed from constant to intermittent, extracorporeal membrane oxygenation (ECMO; right femoral artery and vein) was placed for hemodynamic stability and the patient underwent left stellate ganglion blockade, which further decreased the arrhythmia burden, with no defibrillation shocks required after day 2.