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All Journal Indonesian Journal of Cardiology Heart Science Journal
Dony Yugo Hermanto
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Health Professions Immunology & microbiology Medicine & Pharmacology

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Journal : Heart Science Journal

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Local anesthetic systemic toxicity (LAST) during pacemaker implantation through persistent left superior vena cava (PLSVC) Sunu Budhi Raharjo; Gadistya Novitri Adinda; Dony Yugo Hermanto; Indira Aura Balqis; Dicky Armein Hanafy
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.18

Abstract

BACKGROUND: Local anesthesia is considered safe and commonly used in the pacemaker implantation procedure. However, it carries a risk of local anesthetic systemic toxicity (LAST). Although rare, LAST occurrence can be fatal. CASE PRESENTATIONS: We reported a case of a 69-year-old woman with fatigue and dizziness. The patient's ECG indicates atrial fibrillation with total AV block. Pacemaker implantation was performed under local anesthesia. Within minutes of lidocaine injection, the patient developed a seizure followed by cardiac arrest. Immediate administration of intravenous midazolam and cardiopulmonary resuscitation was done, resulting in the patient's stability. A permanent pacemaker was successfully implanted using a modified hand-shaped stylet to accommodate the presence of a persistent left superior vena cava (PLSVC). Brain computed tomography scan showed only mild brain atrophy. No clinical symptoms were documented during the outpatient visit after discharge. CONCLUSIONS: Local anesthetic systemic toxicity during pacemaker implantation is a rare but potentially catastrophic. Prompt recognition of its signs and appropriate management are crucial. In this case, a persistent left superior vena cava posed additional challenges to the pacemaker implantation.
When the silence breaks: Delayed symptomatic arrhythmia emerging years after tetralogy of fallot repair — A case report Mulawarman, Rido; Dony Yugo Hermanto; Siagian, Sisca
Heart Science Journal Vol. 7 No. 2 (2026): The Evolving Landscape of Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.02.16

Abstract

Background: Surgical repair of Tetralogy of Fallot (TOF) has markedly improved long-term survival in congenital heart disease patients. However, late-onset arrhythmias remain a significant cause of morbidity and can lead to sudden cardiac death. Case summary: We report a 9-year-old boy with a history of complete TOF repair using a transannular patch at the age of 2 years, who presented with recurrent syncope and seizure-like episodes several years postoperatively. Neurological investigations, including brain MRI and electroencephalography, were unremarkable, leading to an initial misdiagnosis of epilepsy. Despite antiepileptic therapy, symptoms persisted. Subsequent 24-hour Holter monitoring demonstrated a high burden of polymorphic premature ventricular complexes (PVCs), non-sustained ventricular tachycardia (NSVT), and episodes of junctional rhythm with chronotropic incompetence. Initiation of oral verapamil resulted in complete resolution of symptoms. An electrophysiological study (EPS) is planned to further characterize the arrhythmic substrate and guide potential definitive intervention. Conclusion: This case emphasizes that late-onset ventricular arrhythmias can occur years after anatomically successful TOF repair and may mimic neurological disorders, delaying accurate diagnosis. Early recognition of arrhythmic mechanisms and timely referral for EPS are essential to optimize management, avoid inappropriate therapy, and mitigate the risk of sudden cardiac death.
Co-Authors Dian Andina Munawar Dicky Armein Hanafy Dony Yugo Hermanto Gadistya Novitri Adinda Ignatius Yansen Indira Aura Balqis Mulawarman, Rido Muzakkir Muzakkir Siagian, Sisca Stephanie Salim Stephanie Salim Sunu Budhi Raharjo Yoga Yuniadi Yoga Yuniadi