An 8-year-old boy who had been living with his grandparents abroad moved to the UK to live with his parents. Three months later, the boy had gone to bed as usual when his mother heard a scream coming from his room. When she went to investigate she found him collapsed on the floor. She called for an ambulance and started CPR. The first responder arrived after 5 min and found the boy to be in pulseless electrical activity; he continued basic life support. When the paramedic crew arrived the boy was intubated, resuscitation was continued, and by 17 min cardiac output had returned. The boy was air-lifted to the children’s hospital for further management.

On arrival in the emergency department the boy had a heart rate of 140–190 bpm, showing a variable rhythm with runs of monomorphic and polymorphic ventricular tachycardia (Fig. 5.4), supraventricular tachycardia, bigemeny and trigemeny. The rhythm changes were noticed to be associated with the painful stimuli such as suction and blood sampling. The boy tolerated the rhythm changes well with no further loss of cardiac output. He was transferred to the intensive care unit where he was cooled for 24 h. During this time his electrolytes were optimized and he was started on lidocaine and esmolol infusions. After 24 h he was re-warmed, sedation was reduced, and he was successfully extubated. The esmolol infusion was changed to oral propranolol and other infusions discontinued. He went on to make a good recovery, and was discharged with no evidence of neurological injury. He has continued to do well and is currently managed on oral flecanide and propranolol.