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Citation
Tags
HERO ID
1330799
Reference Type
Journal Article
Title
"Torsade de pointes" during amiodarone infusion in a cirrhotic woman with a prolonged QT interval
Author(s)
Di Micoli, A; Zambruni, A; Bracci, E; Benazzi, B; Zappoli, P; Berzigotti, A; Zoli, M; Bernardi, M; Trevisani, F
Year
2009
Is Peer Reviewed?
Yes
Journal
Digestive and Liver Disease
ISSN:
1590-8658
EISSN:
1878-3562
Volume
41
Issue
7
Page Numbers
535-538
Language
English
PMID
18294935
DOI
10.1016/j.dld.2007.11.017
Web of Science Id
WOS:000267780600014
Abstract
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.
Keywords
Amiodarone; Cirrhosis; QT-interval; Torsade de pointes
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