Torsades de pointes secondary to intravenous haloperidol after coronary bypass grafting surgery

Area of Science:

• Cardiology
• Pharmacology
• Intensive Care Medicine

Background:

• Postoperative delirium is a common complication following major cardiac surgery, such as coronary artery bypass grafting (CABG).
• Haloperidol is frequently used in intensive care units for managing delirium and is generally considered safe, even at high doses.
• Malignant ventricular arrhythmias, including torsades de pointes, are rarely associated with haloperidol use.

Observation:

• A patient undergoing triple bypass surgery developed delirium requiring high-dose intravenous haloperidol for psychomotor agitation.
• Torsades de pointes occurred on the third postoperative day.
• The arrhythmia developed in the absence of QT prolongation or other identifiable etiological factors, suggesting a direct link to haloperidol administration.

Findings:

• High-dose haloperidol administration in the context of postoperative delirium after myocardial revascularization can precipitate torsades de pointes.
• This specific adverse event occurred without the typical precursor of QT prolongation.

Implications:

• Clinicians must be aware of this rare but serious complication when prescribing haloperidol to post-CABG patients.
• Judicious use of haloperidol is crucial in this patient population due to the potential for life-threatening arrhythmias.
• The underlying cardiac condition in post-CABG patients can exacerbate the consequences of such arrhythmias.