[Drug-induced ventricular tachycardia].
Certain drugs can induce ventricular tachycardia (VT) by creating reentry, ventricular after potentials or exaggerating the slope of phase 4. These may or may not be symptomatic, sustained or non-sustained and have variable ECG appearances: monomorphic or polymorphic, bidirectional, torsades de pointes. They risk degenerating into ventricular flutter of fibrillation and have been held responsible for the increased mortality observed unexpectedly in some long-term treatments. The drugs responsible are mainly those used in cardiology, probably due to predisposing circumstances (cardiomegaly, cardiac failure, previous severe ventricular arrhythmias, therapeutic associations, metabolic abnormalities). These include primarily the antiarrhythmic drugs (IA, IC, sotalol and bepridil), digitalis, sympathomimetics and phosphodiesterase inhibitors. These complications may be toxic or idiosyncratic, in patients with or without cardiac disease, and may also occur with other drugs: vasodilators and anti-anginal drugs (lidoflazine, vincamine, fenoxedil), psychotropic agents (phenothiazine and imipramine), antimitotics, antimalarials (chloroquine) or antibiotics (erythromycin, pentamidine). The prognosis is severe and the treatment is often difficult which makes prevention, helped by repeated surface ECG (or Holter monitoring), very important with careful assessment of patients at risk.
Fauchier
J P
JP
Service de cardiologie B et laboratoire d'électrophysiologie cardiaque, hôpital Trousseau, Tours.
Fauchier
L
L
Babuty
D
D
Breuillac
J C
JC
Cosnay
P
P
Rouesnel
P
P
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects; D004071:Digitalis Glycosides / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006633:Histamine Antagonists / Q000009:adverse effects; D006801:Humans; D008297:Male; D011619:Psychotropic Drugs / Q000009:adverse effects; D013566:Sympathomimetics / Q000009:adverse effects*; D017180:Tachycardia, Ventricular / Q000139:chemically induced*; D016171:Torsades de Pointes / Q000139:chemically induced; D014665:Vasodilator Agents / Q000009:adverse effects
D000889:Anti-Arrhythmia Agents; D000970:Antineoplastic Agents; D004071:Digitalis Glycosides; D006633:Histamine Antagonists; D011619:Psychotropic Drugs; D013566:Sympathomimetics; D014665:Vasodilator Agents
Les tachycardies ventriculaires d'origine médicamenteuse.