Amiodarone-associated 'torsade de pointes'. Relevance of concomitant cardiovascular medication in a patient with atrial fibrillation and structural heart disease

• Published in: Zeitschrift für Kardiologie Vol. 92; no. 10; pp. 889 - 892
• Main Authors: SCHRICKEL, J, BIELIK, H, YANG, A, SCHWAB, J. O, SHLEVKOV, N, SCHIMPF, R, LÜDERITZ, B, LEWALTER, T
• Format: Journal Article
• Language: English
• Published: Darmstadt Steinkopff 01.10.2003
• Subjects: Acetyldigoxins - adverse effects; Acetyldigoxins - therapeutic use; Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Aged; Amiodarone - adverse effects; Amiodarone - therapeutic use; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - therapeutic use; Atrial Fibrillation - drug therapy; Biological and medical sciences; Bisoprolol - adverse effects; Bisoprolol - therapeutic use; Cardiac dysrhythmias; Cardiology. Vascular system; Drug Interactions; Drug Therapy, Combination; Electrocardiography - drug effects; Female; Heart; Heart Failure - drug therapy; Humans; Medical sciences; Torsades de Pointes - chemically induced; Torsades de Pointes - diagnosis; Antianginal agent; Human; Drug; QT interval; Antiarrhythmic drugs; Wave burst; Arrhythmia; Coronary vasodilator agent; Atrial fibrillation; Cardiovascular disease; Amiodarone; Time; Antiarrhythmic agent; proarrhythmia; Excitability disorder; Heart disease; QT-time; torsade de pointes
• ISSN: 0300-5860; 1435-1285
• DOI: 10.1007/s00392-003-0985-5

A 69 year old female with history of coronary heart disease, myocardial infarction and paroxysmal atrial fibrillation suffered from occipital apoplexy. Under treatment with amiodarone 600 mg daily and concomitant medication with beta-acetyldigoxine (0.1 mg daily) and bisoprolole (1.25 mg daily), significant QT-prolongation (max. 700 ms; QTc: 614 ms) could be documented. Out of normofrequent sinus rhythm but as well out of bradycardia, the patient developed repetitive short-lasting "torsade de pointes" tachycardias (320 bpm) which terminated spontaneously. Serum electrolytes, plasma levels of digoxine (1.76 ng/ml) and amiodarone (1.9 mcg/ml) were within therapeutic range. This case report is the first to describe induction of amiodarone-associated "torsade de pointes" tachycardia during concomitant beta-blocker and digitalis medication in a patient with atrial fibrillation and structural heart disease. This points towards an elevated risk for proarrhythmia under this triple therapy.