Key result
Promethazine overdose triggers fascicular VT in a structurally normal heart, successfully terminated with verapamil.
Why the study?
There have been no previous published reports of promethazine precipitating verapamil-sensitive fascicular ventricular tachycardia, highlighting an unusual pro-arrhythmic link.
Does verapamil terminate fascicular ventricular tachycardia precipitated by promethazine overdose?
Case Report (n=1)
Does verapamil terminate fascicular ventricular tachycardia precipitated by promethazine overdose?
This report highlights a novel association between promethazine overdose and the precipitation of verapamil-sensitive fascicular ventricular tachycardia, emphasizing the efficacy of verapamil for termination.
Verapamil may terminate promethazine-associated fascicular VT; single case leaves open causality and generalizability.
Verapamil-sensitive fascicular tachycardia is a type of ventricular tachycardia (VT) involving the specialised cardiac conducting tissue. Drug overdose is an important cause to consider when assessing patients with a new presentation of a broad complex tachycardia. Multiple antihistamines have been implicated as pro-arrhythmic, but these tend to precipitate Torsades de Pointes via drug-induced QT prolongation. We present an educational case of a Verapamil-sensitive fascicular VT with typical electrocardiogram (ECG) characteristics, which developed immediately following an overdose of promethazine and which was terminated successfully with verapamil, in a young person with a structurally normal heart. There have been no previous published reports of promethazine precipitating a fascicular VT and we aim to highlight this unusual link and the benefits of early recognition and management of similar presentations.
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Hassan et al. (2026) conducted a case report in Verapamil-sensitive fascicular ventricular tachycardia (n=1). Promethazine overdose was evaluated on Development of fascicular ventricular tachycardia and termination by verapamil. Promethazine overdose precipitated a Verapamil-sensitive fascicular ventricular tachycardia in a young person with a structurally normal heart, which was successfully terminated with verapamil.
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