Health & Environmental Research Online (HERO)


Print Feedback Export to File
1330799 
Journal Article 
"Torsade de pointes" during amiodarone infusion in a cirrhotic woman with a prolonged QT interval 
Di Micoli, A; Zambruni, A; Bracci, E; Benazzi, B; Zappoli, P; Berzigotti, A; Zoli, M; Bernardi, M; Trevisani, F 
2009 
Yes 
Digestive and Liver Disease
ISSN: 1590-8658
EISSN: 1878-3562 
41 
7 
535-538 
English 
18294935 
WOS:000267780600014 
We describe an interesting case of a woman with decompensated cirrhosis, ischaemic heart disease and prolonged QT interval, who developed a new-onset atrial fibrillation. During amiodarone infusion a torsade de pointes occurred, which was immediately converted to sinus rhythm by synchronized cardioversion. A new episode of atrial fibrillation was treated with infusion of a beta-blocker (metoprolol) that restored sinus rhythm and normalized the QT interval. Delayed repolarization, frequently observed in ischaemic heart disease, cirrhosis and pro-arrhythmic drugs administration, represents the background for the development of torsade de pointes. Our report underlines that the potential harmfulness of a prolonged QT interval in cirrhotic patients is currently not perceived in its entirety, so that various categories of drugs affecting ventricular repolarization are rather thoughtlessly used in clinical practice without monitoring the QT interval. Thus, amiodarone should be avoided, if possible, or used with extreme care in arrhythmic patients with advanced liver disease. Moreover, beta-blockers may be considered the first-line treatment for rate-control during supraventricular tachyarrhythmias in cirrhotic patients with delayed repolarization. 
Amiodarone; Cirrhosis; QT-interval; Torsade de pointes