Torsades de Pointe Associated with Trazodone Consumption.

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Trazodone is a widely prescribed antidepressant.
• It is generally considered safe for cardiac function due to low anticholinergic effects.
• QTc prolongation is a known risk factor for potentially fatal arrhythmias like Torsades de Pointes (TdP).

Observation:

• A 67-year-old female with a history of major depressive disorder (MDD) developed nausea and vomiting six days after starting trazodone (50 mg daily).
• Initial ECG showed a significantly prolonged corrected QT interval (QTc = 586 ms) with ST segment changes and T wave inversion.
• The patient experienced sudden loss of consciousness, and ECG monitoring revealed Torsades de Pointes (TdP), which was successfully treated with defibrillation.

Findings:

• Trazodone-induced QTc prolongation and TdP occurred in a patient without apparent pre-existing risk factors.
• The cardiac arrhythmia resolved after discontinuing trazodone, with normalization of ECG findings within four days.
• Temporary pacemaker implantation was necessary due to recurrent arrhythmias and bradycardia, highlighting the severity of the event.

Implications:

• Trazodone use carries a risk of QTc prolongation and TdP, which can be life-threatening.
• Close cardiac monitoring, including ECG, is essential for patients initiating or using trazodone, especially those with risk factors.
• This case underscores the importance of recognizing and managing trazodone-induced cardiac adverse events.