The Role of Quinine to Prevent Ventricular Fibrillation and ICD Shocks in Early Repolarization Syndrome

The role of quinidine in patients with early repolarization syndrome (ERS) is known, but it is not available in many countries. We share our experience with quinine sulfate in the suppression of ventricular fibrillation in a patient with ERS.

A 25-year-old man presented with cardiac arrest. Electrocardiogram demonstrated J-point elevation with QRS notching in the inferolateral leads. He developed recurrent ventricular fibrillation requiring resuscitation, repeated cardioversions, and intracardiac defibrillator implantation for secondary prevention. Despite amiodarone and propranolol, he experienced repeated intracardiac defibrillator shocks. Initiation of oral quinine achieved sustained suppression of premature ventricular complexes and ventricular fibrillation during 2 years of follow-up.

The suppression of ventricular fibrillation in ERS involves use of quinidine, but access remains a barrier. Even though the use of quinine is reported in the literature in Brugada syndrome, the role of quinine in ERS is rarely reported.

This case highlights the possible role of quinine in suppression of short-coupled premature ventricular complexes and ventricular fibrillation in patients with ERS.