Amiodarone is generally regarded to have a high safety profile with a low incidence of arrhythmias. However, there have been reports of torsades de pointes under certain conditions, such as electrolyte imbalance or concomitant antiarrhythmic therapy. We describe a case of amiodarone-induced torsade de pointes early after initiation of intravenous amiodarone in the setting of T-wave alternans.
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Cureus
November 2023
Cardiology, Centro Hospitalar Universitário de Santo António, Porto, PRT.
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.
View Article and Find Full Text PDFAnn Noninvasive Electrocardiol
November 2021
Department of Medical Engineering, Yawatahama City General Hospital, Ehime, Japan.
An elderly Japanese woman developed acute decompensated heart failure caused by persistent atrial fibrillation (AF) and left ventricular systolic dysfunction. Approximately 6 days after starting intravenous administration of amiodarone (600 mg/day) for maintaining sinus rhythm after cardioversion of AF, electrocardiograms revealed a prolonged QT interval associated with torsade de pointes (TdP). The amiodarone-induced TdP disappeared after intravenous administration of landiolol plus magnesium and potassium, without discontinuation of amiodarone or overdrive cardiac pacing, although the prolonged QT interval persisted.
View Article and Find Full Text PDFJACC Case Rep
May 2020
Cardiology Department, Changi General Hospital, Singapore.
A woman with ischemic cardiomyopathy presented with recurrent syncope. Electrocardiogram showed complete heart block and torsade de pointes (TdP) secondary to amiodarone, recently started for paroxysmal atrial fibrillation. We describe a novel application of His bundle pacing that suppressed TdP and corrected the underlying left bundle branch block.
View Article and Find Full Text PDFCardiovasc Endocrinol Metab
December 2019
HCA Ocala Regional Medical Center, Interventional Cardiology and Electrophysiology.
This case involves a 55-year-old male patient with systolic heart failure and refractory atrial fibrillation due to thyrotoxicosis, who was electrically cardioverted but then developed torsade de pointes and ventricular fibrillation. Rate control was unsuccessful with digoxin, cardizem, labetalol, esmolol and amiodorone. Patient was externally cardioverted after which ECGs showed prolonged QT with frequent premature ventricular contractions.
View Article and Find Full Text PDFOxf Med Case Reports
January 2019
Department of Cardiovascular Medicine, First Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, China.
The risk factors of acquired long QT syndrome (aLQTS) are sometimes overlooked in clinics. Drugs, hypokalemia, age and female sex are well-known risk factors of QT prolongation-dependent torsade de pointes (TdP), which explains the high incidence of sudden cardiac death in LQT patients. Here, we report a case of an elderly female patient with lung cancer who was in poor condition, for whom amiodarone was mistakenly prescribed to rectify premature ventricular contractions.
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