A Heart Under Stress: Anaesthetic Strategy for a Pregnant Patient With Long QT Syndrome

Long QT syndrome (LQTS) is a cardiac channelopathy associated with a high risk of malignant arrhythmias. Hormonal changes during pregnancy, especially in the peripartum period, increase the risk of adverse cardiac events in women with LQTS. Anaesthetic management in these patients is challenging, as there are no established guidelines and most anaesthetic agents prolong the QT interval. This report describes the anaesthetic management of an elective caesarean section in a 34-year-old pregnant woman, 35 weeks pregnant, with congenital LQTS type 1 (LQTS1), a corrected QT interval (QTc) of 597 milliseconds (ms) on the admission day, and a high cardiovascular risk. Given the high arrhythmic risk, perioperative planning and management were undertaken by a multidisciplinary team to optimise patient outcomes and minimise risks. Total intravenous anaesthesia with propofol and remifentanil was used, alongside strict electrolyte optimisation, sympathetic control, and continuous advanced monitoring. Careful perioperative planning and appropriate monitoring can enable the safe use of general anaesthesia for caesarean section in selected women with LQTS1.