title: A Perfect Storm: Tyrosine Kinase Inhibitor-Associated Polymorphic Ventricular Tachycardia.
abstract: BACKGROUND
  Oral tyrosine kinase inhibitors (TKIs) are becoming increasingly common in oncology practice due to ease of administration and patient preference. This class of medications is relatively unknown to emergency physicians.
  
  
  METHODS
  Here we present a case of electrical storm (ES) thought to be associated with ibrutinib, a TKI. The ES was unabated despite antidysrhythmic therapy and electrical cardioversion, and was treated with supportive care, which eventually included the use of extracorporeal membrane oxygenation. This patient had no risk factors or apparent causes of recurrent ventricular tachycardia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ES has not previously been described with ibrutinib, but may be associated with off-target effects of the drug.
authors.affiliation: Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Alexander
authors.initials: A
authors.lastname: Beyer
authors.affiliation: Pharmacy Department, Henry Ford Health System, Detroit, Michigan.
authors.forename: Beejal
authors.initials: B
authors.lastname: Ganti
authors.affiliation: Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Allen
authors.initials: A
authors.lastname: Majkrzak
authors.affiliation: Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Nik
authors.initials: N
authors.lastname: Theyyunni
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives; D000638:Amiodarone / Q000494:pharmacology / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use; D004554:Electric Countershock / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D004594:Electrophysiology / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007423:Intra-Aortic Balloon Pumping / Q000379:methods; D007545:Isoproterenol / Q000494:pharmacology / Q000627:therapeutic use; D008012:Lidocaine / Q000494:pharmacology / Q000627:therapeutic use; D008274:Magnesium / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010880:Piperidines; D011720:Pyrazoles / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods; D013575:Syncope / Q000209:etiology; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D016171:Torsades de Pointes / Q000175:diagnosis / Q000188:drug therapy; D008258:Waldenstrom Macroglobulinemia / Q000188:drug therapy; D000078329:Workforce
chemical_list: D000889:Anti-Arrhythmia Agents; D000970:Antineoplastic Agents; D002316:Cardiotonic Agents; D010880:Piperidines; D011720:Pyrazoles; D011743:Pyrimidines; C551803:ibrutinib; D008012:Lidocaine; D008274:Magnesium; D000225:Adenine; D007545:Isoproterenol; D000638:Amiodarone
keywords: dysrhythmia; electrical storm; ibrutinib; torsades des pointes; tyrosine kinase inhibitor; ventricular storm