The successful use of verapamil in infants with fascicular ventricular tachycardia

A case report of a 7 day old neonate and a 16 month old infant both of whom presented with sustained tachyarrhythmia that was identified as fascicular ventricular tachycardia, a.k.a. verapamil sensitive ventricular tachycardia. This is a rare but well described tachycardia in the pediatric population. Fascicular VT is known to be both highly sensitive to verapamil and poorly responsive to other first-line tachyarrhythmia treatments. This is of clinical importance as verapamil is considered contraindicated in this age group given numerous reports of hemodynamic collapse or profound atrioventricular block following intravenous administration. Both of our cases described here failed initial non-calcium channel blockade treatment and ultimately were successfully treated with IV verapamil. We describe the rare case in which verapamil should be considered in treatment of a pediatric ventricular tachyarrhythmia. Our cases further exemplify that verapamil can be effectively used in the neonatal and infant population provided there is appropriate hemodynamic support available. •We report on a neonate and infant with incessant left ventricular fascicular VT.•Verapamil was effectively used to treat neonatal and infant VT in these patients.•Initiation of verapamil for infant fascicular VT, with ICU support, is reasonable.•Multi-center study is needed to assess verapamil use in infants with fascicular VT.