Torsade des pointes and aprindine.

Area of Science:

• Clinical Cardiology
• Pharmacology
• Electrophysiology

Background:

• An 88-year-old patient with atrial fibrillation and ventricular premature depolarizations was treated with aprindine.
• Aprindine is an antiarrhythmic medication.
• Cardiac arrhythmias require careful management due to potential adverse effects.

Observation:

• Oral administration of aprindine initially restored sinus rhythm and eliminated premature beats.
• Treatment with aprindine resulted in QT interval prolongation and prominent U waves.
• Ventricular arrhythmia, specifically torsade des pointes, emerged 36 hours after discontinuing aprindine.

Findings:

• Aprindine effectively suppressed premature ventricular depolarizations and restored normal sinus rhythm.
• Aprindine administration was associated with significant QT interval prolongation.
• Discontinuation of aprindine precipitated torsade des pointes, indicating a proarrhythmic effect.

Implications:

• Aprindine may possess both antiarrhythmic and proarrhythmic properties.
• Prolongation of the QT interval by aprindine may render the myocardium vulnerable to potentially fatal arrhythmias like torsade des pointes.
• This case highlights the critical need for monitoring cardiac electrophysiology during and after aprindine treatment.