Torsades de pointes as a manifestation of mexiletine toxicity

An episode of torsades de pointes, an unusual ventricular tachyarrhythmia, developed in a 59-year-old coronary patient who was treated with 100 mg. four times a day mexiletine orally. The PR, QRS, and QT intervals were normal. The ventricular arrhythmias resembled in part, the patient's previous ventricular premature complexes, but there were some relevant morphological differences. The plasma electrolytes were within normal limits. Mexiletine, which is chemically and electrophysiologically similar to lidocaine, probably caused this arrhythmia. Although mexiletine is a useful antiarrhythmic drug, it should be added to the list of drugs associated with atypical ventricular tachycardia.