Successful management of cesarean section in a patient with Romano–Ward syndrome using landiolol, a selective and short-acting β1 receptor antagonist

Abstract

Romano–Ward (R-W) syndrome is an autosomal dominant hereditary disorder and is characterized by a prolonged QT interval on the electrocardiogram (ECG), syncope, and sudden death. We report here a case of cesarian section in a patient with R-W syndrome whose QT prolongation was successfully managed with landiolol, a selective β1 receptor blocker. A 25-year-old woman with R-W syndrome was scheduled for cesarean section. In the operating room, the patient’s ECG showed tachycardia (102 beats·min⁻¹) and marked QT prolongation (QTc = 0.56 s). After spinal anesthesia, the patient’s heart rate (HR) increased to 130 beats/min accompanied by a slight decrease in arterial blood pressure to 97/57 mmHg and the QTc was prolonged to 0.57 s. Landiolol was continuously infused at a rate of 0.04 mg·kg⁻¹·min⁻¹ and the HR gradually decreased to 80–90 beats·min⁻¹ accompanied by the normalization of QTc to 0.48 s. We thought that the use of landiolol was more rational and was preferable to a nonselective β receptor blocker for a term-pregnant woman because blockade of the β2 receptor might cause uterine contraction. After the use of landiolol, intraoperative and postoperative courses in both the patient and the baby were uneventful.