• Hironori Ishizaki, Hiroaki Murata, Takuji Maekawa, Taiga Ichinomiya, and Tetsuya Hara.
• Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan.
• Medicine (Baltimore). 2021 Nov 24; 100 (47): e27790e27790.

RationaleCongenital long QT syndrome (LQTS) can cause syncope or sudden death due to ventricular arrhythmia. Congenital LQTS has 3 major types, 1, 2, and 3. Life-threatening arrhythmias are triggered by emotion in patients with LQTS type 2. As patients with LQTS type 2 have a higher incidence of postnatal cardiac events, careful perinatal management especially during delivery is required. To the best of our knowledge, perinatal management of a patient with LQTS type 2 has not been properly described with consideration to its type-specific risk factors for ventricular tachyarrhythmia.Patient ConcernsA 36-year-old pregnant woman, gravida 1, para 0, with LQTS type 2 was scheduled to undergo vaginal delivery under epidural labor analgesia in the 38th week of pregnancy. No fainting episodes were reported since she began to take 40 mg of propranolol once daily at the age of 25. Despite this, we instituted maximum preventive measures for the safety of both the parturient and the fetus to minimize the risk of maternal cardiac events throughout the perinatal period.DiagnosesShe was diagnosed with LQTS type 2 by genetic testing at the age of 25.InterventionsTwo epidural catheters were placed at levels T11-T12 and L5-S1. Injection of 0.2% ropivacaine and subsequent infusion of ropivacaine 0.1% with fentanyl (2 μg/mL) was directed through each catheter according to the stage of labor. Concurrently, landiolol, a selective and short-acting β1 receptor antagonist, was infused intravenously at a dose of 1 to 7 μg/kg/min.OutcomesThe delivery proceeded uneventfully without pain. No adverse cardiac events were observed during the perinatal period.LessonsVaginal delivery under epidural labor analgesia using 2 catheters might be a viable option for maternal perinatal care and delivery of patients with LQTS type 2.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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