Amiodarone-associated "torsade de pointes". Relevance of concomitant cardiovascular medication in a patient with atrial fibrillation and structural heart disease.
A 69 year old female with history of coronary heart disease, myocardial infarction and paroxysmal atrial fibrillation suffered from occipital apoplexy. Under treatment with amiodarone 600 mg daily and concomitant medication with beta-acetyldigoxine (0.1 mg daily) and bisoprolole (1.25 mg daily), significant QT-prolongation (max. 700 ms; QTc: 614 ms) could be documented. Out of normofrequent sinus rhythm but as well out of bradycardia, the patient developed repetitive short-lasting "torsade de pointes" tachycardias (320 bpm) which terminated spontaneously. Serum electrolytes, plasma levels of digoxine (1.76 ng/ml) and amiodarone (1.9 mcg/ml) were within therapeutic range. This case report is the first to describe induction of amiodarone-associated "torsade de pointes" tachycardia during concomitant beta-blocker and digitalis medication in a patient with atrial fibrillation and structural heart disease. This points towards an elevated risk for proarrhythmia under this triple therapy.
Schrickel
J
J
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. Jan.Schrickel@ukb.uni-bonn.de
Bielik
H
H
Yang
A
A
Schwab
J O
JO
Shlevkov
N
N
Schimpf
R
R
Lüderitz
B
B
Lewalter
T
T
D000113:Acetyldigoxins / Q000009:adverse effects / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000638:Amiodarone / Q000009:adverse effects* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D017298:Bisoprolol / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000175:diagnosis
D000113:Acetyldigoxins; D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000638:Amiodarone; D017298:Bisoprolol