Trauma triggered catecholaminergic polymorphic ventricular tachycardia manifesting as cardiac arrest in a child: a...

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited, stress-provoked arrhythmia that can precipitate life-threatening ventricular fibrillation, syncope, or sudden cardiac death. Although most CPVT cases arise from pathogenic variants in the cardiac ryanodine receptor gene (RYR2), data on trauma-triggered episodes in children remain scarce.

A previously healthy 18-month-old Chinese boy suffered cardiopulmonary arrest after falling from a chair. Following return of spontaneous circulation, he developed acute heart failure and polymorphic ventricular tachycardia. During the acute phase, analgo-sedation, invasive mechanical ventilation, targeted temperature management, and veno-arterial extracorporeal membrane oxygenation (ECMO) were instituted. Subsequent genetic analysis revealed a de novo missense variant in RYR2, leading to a diagnosis of CPVT. Long-term oral propranolol was initiated, and no further arrhythmic episodes have been observed to date.

For previously healthy children who experience cardiac arrest or syncope triggered by minor trauma, CPVT should be strongly suspected. Targeted diagnostic evaluation and early genetic testing are warranted to facilitate timely diagnosis. Additionally, ECMO support should be considered when conventional resuscitative measures fail and life-threatening hemodynamic instability occurs.