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Pulseless Ventricular Tachycardia With Propofol Infusion Syndrome in Severe Acute Respiratory Distress Syndrome

Year: 2026

Type: article

Abstract: BACKGROUND: Propofol Infusion Syndrome (PRIS) is a rare, potentially fatal complication of prolonged or high-dose propofol exposure characterized by mitochondrial dysfunction, rhabdomyolysis, metabolic derangements, and cardiovascular collapse. The classically described mode of cardiac death is bradycardia progressing to asystole. CASE SUMMARY: A previously healthy 21-year-old woman presented 5 days after a vaginal delivery with severe acute respiratory distress syndrome requiring sedation with propofol escalated to 100 μg/kg/min. She developed rhabdomyolysis, acute kidney injury, hyperkalemia, acidosis, and progressive ventricular ectopy that evolved into pulseless ventricular tachycardia. Propofol was stopped, and continuous renal replacement therapy was arranged, but the patient experienced cardiac arrest before initiation. No arrhythmias occurred after metabolic correction. DISCUSSION: This case highlights pulseless ventricular tachycardia as a rare cardiac manifestation of PRIS with evolving metabolic abnormalities before cardiovascular collapse occurs. TAKE-HOME MESSAGES: Rhabdomyolysis and hyperkalemia during prolonged propofol therapy should prompt evaluation for PRIS. Early propofol discontinuation and aggressive metabolic correction may prevent fatal ventricular arrhythmias.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.110253