Key result
Intravenous amiodarone administration in a 42-year-old female with baseline QT prolongation and electrolyte abnormalities was associated with the development of recurrent torsades de pointes.
Case Report (n=1)
This case highlights the risk of amiodarone-induced Torsades de Pointes in patients with underlying QT prolongation and electrolyte abnormalities.
A 42 year old female presented with epigastric pain of one day duration, 5 days after starting erythromycin for cellulitis. In the ER, she had a cardiopulmonary arrest. During resuscitation she developed recurrent ventricular fibrillation requiring conversion with more than 3 D/C shocks for which she was started on IV amiodarone. Baseline, and current electrocardiograms showed QT prolongation, with hypokalemia and hypomagnesemia on blood tests (immediately supplemented). However, patient developed torsades de pointes (TDP) associated with seizures and hypotension, responding to D/C cardioversion every 1-2 hours. The amiodarone drip was stopped due to worsening QT prolongation, and Isoproterenol infusion was started to maintain a HR of 100 beats/min. Subsequently a transvenous pacemaker was inserted terminating the TDP, pending implantable cardioverterdefibrillator (ICD) insertion.
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A 2007 study conducted a case report in Torsades de pointes (n=1). Amiodarone was evaluated on Torsades de pointes. Intravenous amiodarone administration in a 42-year-old female with baseline QT prolongation and electrolyte abnormalities was associated with the development of recurrent torsades de pointes.
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