Serious case of the hiccups

Case report An 8 year-old boy had been treated for 2 years for exerciserelated “seizures” unresponsive to phenobarbital and levetiracetam. He presented to an outside hospital after an episode of loss of consciousness while playing laser tag. The episode was thought to be a seizure but lasted 45 minutes, so Emergency Medical Services was called. When Emergency Medical Services arrived, he was in ventricular fibrillation and was successfully defibrillated. He was transported to the local hospital, where he experienced multiple episodes of ventricular arrhythmia in the emergency department. Ventricular tachycardia that degenerated into ventricular fibrillation occurred during IV placement. Defibrillation was again successful, but polymorphic ventricular tachycardia recurred and became incessant after administration of epinephrine and amiodarone. The patient was transported to a regional tertiary pediatric hospital for further treatment. A diagnosis of catecholaminergic polymorphic ventricular tachycardia was suspected based on a normal baseline electrocardiogram (ECG), bidirectional ectopy, and ventricular tachycardia that had worsened with epinephrine. Later genetic testing confirmed an RYR2 mutation. He was treated acutely with intravenous esmolol, and the epinephrine and amiodarone were discontinued. The patient recovered from the cardiac arrest and had near-normal mentation and normal ventricular function. Five days after admission, he underwent single-chamber ICD placement with a St. Jude Durata 7122Q (St. Jude Medical, St. Paul, MN) lead. The implant procedure was