Torsades de pointes after prolonged intravenous amiodarone therapy for atrial fibrillation

Nordkin, Irina; Levinas, Tatyana; Rosenfeld, Inna; Halabi, Majdi

doi:10.1002/ccr3.3539

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…According to the literature, the incidence of amiodarone-induced TdP is less than 1% [ 11 ], and it increases with IV administration [ 12 ]. TdP usually occurs within 24 hours after initiation of the IV therapy [ 12 ], but it can happen even three days after amiodarone infusion [ 11 ]. However, it is extremely rare for short-time administration of amiodarone to cause LQTS and TdP [ 11 - 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…TdP usually occurs within 24 hours after initiation of the IV therapy [ 12 ], but it can happen even three days after amiodarone infusion [ 11 ]. However, it is extremely rare for short-time administration of amiodarone to cause LQTS and TdP [ 11 - 13 ]. The risk factors for malignant arrhythmias in amiodarone-induced LQTS are rapid amiodarone administration, renal failure, acute myocardial infarction, heart failure, hypokalemia, hypomagnesemia, genetic predisposition, bradycardia, QTc interval >500 ms and/or QTc interval increase by ≥60 ms from the baseline value [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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QT Prolongation Preceding Ventricular Fibrillation After Amiodarone Administration: A Case Report

Stojanovic,

Nikolic,

Nedeljkovic

et al. 2024

Cureus

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Atrial fibrillation (AF) is the most common long-term arrhythmia in adults. Rhythm control in patients with AF involves efforts to restore and maintain sinus rhythm and is accomplished by medication, catheter ablation, or electrical cardioversion. Amiodarone represents one of the most commonly used antiarrhythmic medications. Prolonged use of amiodarone can lead to many side effects. One of the most severe side effects is drug-induced long QT syndrome (LQTS), which can cause malignant arrhythmias and sudden cardiac death. We presented a case of a 52-year-old male who was admitted to the Coronary Unit due to first diagnosed AF with a rapid ventricular response. After amiodarone infusion was administrated the patient lost consciousness and the monitor displayed torsades de pointes (TdP) ventricular tachycardia with rapid conversion to ventricular fibrillation (VF). Cardiac resuscitation with two direct current (DC) shocks was performed. The patient was stabilized, and restoration of sinus rhythm with significant QT prolongation on the ECG was noted. This is a rare case of short-term amiodarone administration causing LQTS, TdP, and VF. The findings or observations emphasize the significance of diligent ECG monitoring during amiodarone treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

QT Prolongation Preceding Ventricular Fibrillation After Amiodarone Administration: A Case Report

Stojanovic,

Nikolic,

Nedeljkovic

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…It acts mainly by blocking the potassium channels, resulting in the prolongation of myocardial repolarization, represented by prolongation of the QT interval, particularly in the setting of predisposing conditions such as left ventricular hypertrophy, bradycardia, hypokalemia, and hypomagnesemia [2,3]. Although rare, amiodarone-induced polymorphic ventricular tachycardia is a potentially fatal complication [1][2][3][4][7][8][9]. Therefore, we hypothesized that the use of intravenous amiodarone and the presence of multiple precipitating risk factors (e.g., hypokalaemia and hypomagnesemia) put our patient at increased risk of developing prolonged QT and, subsequently, potentially life-threatening arrhythmic storm.…”

Section: Discussionmentioning

confidence: 99%

Amiodarone-Induced Electrical Storm: A Nightmare in the Emergency Room

Campinas,

Pereira Santos,

Sousa

et al. 2023

Cureus

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Drug-induced long QT syndrome (LQTS) is defined as prolonged corrected QT interval (QTc ≥460 ms) plus polymorphic ventricular arrhythmia fitting the description of torsades de pointes temporally associated with the administration of a drug or combination of drugs. Amiodarone therapy is a known uncommon cause of acquired QT interval prolongation that should not be underestimated. We present a case of an iatrogenic electrical storm with atrial fibrillation (AF) in which amiodarone was administered to attempt chemical cardioversion, resulting in an unnoticed prolongation of the QT interval, with subsequent repeated polymorphic ventricular tachycardia, managed with isoproterenol. Concomitant drugs and slight electrolyte disturbances potentiated this phenomenon. Given the widespread use of this drug in the emergency department, our case highlights a pertinent matter for all medical emergency practitioners. Additionally, it stresses the significance of potential precipitating factors, such as electrolyte imbalances, which are clinical conditions very frequent in the emergency context, along with the importance of recognizing drug interactions. Finally, this case also emphasizes the vital importance of closely monitoring the patient's receiving amiodarone.

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Amiodarone/bisoprolol

2021

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Torsades de pointes after prolonged intravenous amiodarone therapy for atrial fibrillation

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 4 publications

References 14 publications

QT Prolongation Preceding Ventricular Fibrillation After Amiodarone Administration: A Case Report

QT Prolongation Preceding Ventricular Fibrillation After Amiodarone Administration: A Case Report

Amiodarone-Induced Electrical Storm: A Nightmare in the Emergency Room

Amiodarone/bisoprolol

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