Key result
Extravascular ICD prevents out-of-hospital arrest in a patient with methadone-related QT prolongation and recurrent PMVT.
Why the study?
Methadone is highly effective for opioid use disorder but poses risks of QT prolongation and life-threatening arrhythmias, creating a clinical dilemma between arrhythmia risks and addiction treatment outcomes.
Does extravascular ICD placement prevent out-of-hospital arrest and allow ongoing therapy in patients with methadone-induced polymorphic ventricular tachycardia?
Does extravascular ICD placement prevent out-of-hospital arrest and allow ongoing therapy in patients with methadone-induced polymorphic ventricular tachycardia?
ICD placement may be a viable strategy to prevent sudden cardiac death in select high-risk patients with methadone-induced QT prolongation and arrhythmias who cannot transition to alternative opioid use disorder therapies.
May support ICD use to avert arrest in select methadone-related recurrent PMVT; leaves open need for prospective data before broader adoption.
Methadone is a highly effective medication for opioid use disorder (OUD) but has a risk of QT prolongation and life-threatening arrhythmias. This case report presents a patient with OUD on methadone treatment who experienced syncopal episodes due to recurrent episodes of polymorphic ventricular tachycardia (PMVT). Due to the effectiveness of methadone and prior lack of response to alternative treatments, including buprenorphine, rather than methadone dose-reduction, the patient ultimately received an extravascular implantable cardioverter defibrillator (ICD) for prevention of out-of-hospital arrest. This case highlights an important clinical dilemma in balancing the risks of procedures and arrhythmias with improved OUD-related outcomes with methadone. In this report, we review the literature and advocate for consideration of ICD placement in select, high-risk patients with methadone-related QT prolongation or arrhythmias.
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Yang et al. (2025) studied this question. Implantable cardioverter defibrillator placement effectively prevents out-of-hospital arrest in a patient with methadone-related QT prolongation and recurrent PMVT.
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