Induction of life-threatening supraventricular tachycardia during central venous catheter placement: an unusual complication

Cardiac arrhythmias during central venous catheter (CVC) insertion are typically transient events with no hemodynamic repercussions. Pediatric reports on this condition are scarce and fail to describe potentially life-threatening complications. Case: A 14-day-old boy was admitted to the pediatric intensive care unit presenting with septic shock. During CVC insertion, the patient developed supraventricular tachycardia (SVT), which was unresponsive to vagal maneuvers or adenosine. Chest roentgenogram control revealed the tip of the catheter positioned in the midportion of the superior vena cava. After 30 minutes, the patient had a heart rate of 215 beats/min (bpm) and signs of hemodynamic compromise. The SVT eventually reverted to a sinus rhythm with synchronized cardioversion. The patient was discharged in good health. Conclusion: Awareness of this potential complication of CVC insertion warrants a high level of concern by pediatric surgeons performing these procedures. Patients with sepsis and/or cardiac dysfunction who present SVT during catheter insertion can represent a therapeutic challenge for surgeons. (C) 2010 Elsevier Inc. All rights reserved.