Key result
Intravenous amiodarone administration in a 71-year-old man resulted in extreme QT prolongation (QTc = 640ms) and a prolonged, 3-minute episode of self-terminating ventricular fibrillation.
Case Report (n=1)
No
This case demonstrates an unusually prolonged (over 3 minutes) but self-terminating episode of ventricular fibrillation induced by amiodarone and clarithromycin, highlighting the critical need for continuous rhythm monitoring in patients with extreme QT prolongation.
Answers are grounded in this paper and cite their sources.
May warrant QTc monitoring with IV amiodarone plus CYP3A4 inhibitors; hypothesis-generating case report that leaves broader risk open.
A 71-year-old man with a recent diagnosis of pneumonia developed paroxysmal atrial fibrillation and was admitted to the cardiology service. Amiodarone was administered intravenously to restore sinus rhythm. Significant prolongation of the QT interval (QTc = 640ms) was noted and an exceedingly prolonged (over 3 minutes), self-terminating, episode of ventricular flutter/fibrillation occurred during bedside monitoring. The event was terminated without first converting to a more organized ventricular rhythm and without any adverse neurological sequelae. Apart from the long duration of ventricular fibrillation and its spontaneous termination, our case highlights the importance of the continuous heart rhythm monitoring in patients with extreme QT interval prolongation.
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Tziatzios et al. (2020) conducted a case report in Paroxysmal atrial fibrillation (n=1). Amiodarone was evaluated on Development of Torsades de Pointes and ventricular fibrillation. Intravenous amiodarone administration in a 71-year-old man resulted in extreme QT prolongation (QTc = 640ms) and a prolonged, 3-minute episode of self-terminating ventricular fibrillation.
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