2026 SOAP Annual Meeting

Anesthetic Management of Cesarean Delivery in a Parturient with Congenital Long QT Syndrome and an Implantable Cardioverter-Defibrillator

Background

uCongenital long QT syndrome (LQTS) is a rare cardiac channelopathy

uPregnancy and delivery increase arrhythmic risk

uPresence of an Implantable Cardioverter-Defibrillator (ICD) adds perioperative complexity

uEarly anesthesia involvement enables proactive risk mitigation and multidisciplinary planning

Case

uPatient

u42-year-old G3P1 with congenital Long QT Syndrome

uPrior ventricular fibrillation arrest → ICD

uIntermittent beta-blocker adherence; QTc 434-448 ms

uPerioperative Management

uAdmission to telemetry with aggressive repletion

uMultidisciplinary care

uICD interrogation

uAnesthetic Plan

uCesarean delivery with CSE technique

uAvoided QT-prolonging medications

uPhenylephrine for hemodynamic support

uPreemptive, aggressive analgesia

uOutcome

uUncomplicated cesarean delivery

uNo perioperative arrhythmias

uPostpartum Course

uEnvironmental safeguards

uAbdominal pain → aggressive analgesia (improved by POD2)

uContinued electrolyte repletion

uPOD2 headache → conservative management

Teaching

uCongenital Long QT Syndrome requires strict avoidance of QT-prolonging medications

uElectrolyte optimization is critical throughout the peri- and postpartum period

uNeuraxial anesthesia with avoidance of epinephrine to minimize sympathetic stimulation

uPhenylephrine preferred over ephedrine in LQTS patients

uPerioperative management of Implantable Cardioverter-Defibrillator (ICD) is essential

uPeri/Postoperative pain and physiologic stress increases arrhythmic risk → aggressive analgesia is key

uMultidisciplinary coordination = better outcomes in high-risk cardiac parturients

uSystem-level safeguards (equipment readiness, visual reminders) reduce risk of medication and response errors

Anesthetic Management of Cesarean Delivery in a Parturient with Congenital Long QT Syndrome and an Implantable Cardioverter-Defibrillator