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Amiodarone-induced ventricular fibrillation

J M McComb, K R Logan, M M Khan

    European Journal of Cardiology
    |January 1, 1980
    PubMed
    Summary
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    Amiodarone treatment for supraventricular tachyarrhythmias in sick sinus syndrome patients can prolong the Q-T interval, leading to dangerous ventricular arrhythmias like torsade de pointes. Caution is advised due to the risk of lethal cardiac events.

    Area of Science:

    • Cardiology
    • Clinical Pharmacology

    Background:

    • Sick sinus syndrome (SSS) is a common cause of bradycardia and requires management of associated tachyarrhythmias.
    • Amiodarone is frequently used for supraventricular tachyarrhythmias, often at high doses, with a perceived wide safety margin.

    Observation:

    • A patient with SSS was treated with amiodarone (600 mg daily) for supraventricular tachyarrhythmias.
    • Prolongation of the Q-T interval was noted after 20 days of amiodarone therapy.
    • The patient subsequently developed ventricular flutter, ventricular fibrillation, and torsade de pointes on day 28.

    Findings:

    • Amiodarone therapy, even at standard doses, can induce life-threatening ventricular arrhythmias in patients with SSS.
    • The observed Q-T interval prolongation is a potential predictor of amiodarone-induced proarrhythmia.

    Related Experiment Videos

  • Temporary cardiac pacing effectively managed episodes of ventricular fibrillation.

    • Implications:

    • The safety margin of amiodarone may be narrower than previously suggested, particularly in patients with SSS.
    • Close electrocardiographic monitoring for Q-T interval changes is crucial during amiodarone treatment.
    • Risk-benefit assessment is essential before initiating amiodarone, especially in patients predisposed to arrhythmias.