We report two patients who developed symptomatic life-threatening ventricular tachyarrhythmias with changing QRS axes (resembling torsades de pointes), during treatment of their supraventricular tachycardias with oral amiodarone. Like other effects of amiodarone on the body, the arrhythmias became evident several days after initiating therapy, at which time electrocardiographic QT prolongation was present. The arrhythmias subsided after amiodarone treatment was withdrawn. No other drugs or electrolyte disturbances could be incriminated as a cause.
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References
1.
Cordarone, X. (1980). Amiodarone Hydrochloride. Product monograph, published by Labaz, Regent House, Heaton Lane, Stockport. Aspects of Safety and Tolerance 26.
Horan, D.L.G. & Flowers, N.C. (1980). Data for computation of heart rate and values for maximum QT intervals at various heart rate in adults. In Heart Disease, ch. 7, ed. E. Braunwald, p. 210. London/ Philadelphia/Toronto: W. B. Saunders Co.
4.
Krikler, D.M. & Curry, P.V.L. (1976). Torsade de pointes, an atypical ventricular tachycardia . Br. Heart J., 38, 117-120.
5.
Laakso, M. , Pentikainen, P.J. & Pyorala, K. (1981). Sotolol and the QTc interval. Lancet, ii, 1168.
Podrid, P.J. & Lown, B. (1981). Amiodarone therapy in symptomatic, sustained refractory atrial and ventricular tachyarrhythmias. Am. Heart J., 101, 374-379.
11.
Rinkenberger, R.L. , Prystowsky, E.N., Jackman, W.M., Naccarelli, G.V., Heger, J.J. & Zipes, D.P. (1982). Drug conversion of nonsustained ventricular tachycardia to sustained ventricular tachycardia during serial electrophysiologic studies: identification of drugs that exacerbate tachycardia and potential mechanisms . Am. Heart J., 103, 177-184.
12.
Sallou, B. , Cherrier, J.F., Ballan, B., Marthan, G. & Broustet, J.P. (1981). Torsades de pointe et atteinte hepatique au cours d'un traitment associant maleate de perhexiline, amiodarone et acide tienilique. Concours Med., 103, 4757-4760.
13.
Sclarovsky, S. , Strasberg, B., Lewin, R.F. & Agmon, J. (1979). Polymorphous ventricular tachycardia: clinical features and treatment. Am. J. Cardiol., 44, 339-344.
14.
Sclarovsky, S. , Lewin, R.F., Kracoff, O., Strasberg, B., Arditti, A. & Agmon, J. (1983). Amiodarone-induced polymorphous ventricular tachycardia . Am. Heart J., 105, 6-12.
15.
Smith, W.M. & Gallagher, J.J. (1980). 'Les Torsades de Pointes': an unusual ventricular arrhythmia. Ann. Intern. Med., 93, 578-584.
16.
Sobol, S.M. & Rokita, L. (1979). Amiodarone. Circulation, 60, 1426-1427.
17.
Tartini, R. , Kappenberger, L., Steinbrunn, W. & Meyer, U.A. (1982). Dangerous interactions between amiodarone and quinidine. Lancet, i, 1327-1329.
18.
Veglia, L. , Scandiffio, T. & Guerricchio, G. (1978). 'Torsioni di Punta' e amiodarone . G. Ital. Cardiol, 8, 1025-1029.
19.
Velebit, V. , Podrid, P., Lown, B., Cohen, B.H. & Graboys, T.B. (1982). Aggrevation and provocation of ventricular arrhythmias by antiarrhythmic drugs. Circulation, 65, 886-892.
20.
Ward, D.E. , Camm, A.J. & Spurrell, R.A.J. (1980). Clinical antiarrhythmic effects of amiodarone in patients with resistant paroxysmal tachycardias. Br. Heart J., 44, 91-95.
21.
Waxman, H.L. , Groh, W.C., Marchlinski, F.E. et al. (1982). Amiodarone for control of sustained ventricular tachyarrhythmia: clinical and electrophysiologic effects in 51 patients. Am. J. Cardiol., 50, 1066-1074.
22.
Westveer, D.C. , Gadowski, G.A., Gordon, S. & Timmis, G.C. (1982). Amiodarone-induced ventricular tachycardia. Ann. Intern. Med., 97, 561-562.
23.
Zilcher, H. , Glogar, D. & Kaindl, F. (1980). Torsades de Pointes: occurrence in myocardial ischaemia as a separate entity. Multiform ventri-tachycardia or not? Eur. Heart J., 1,63-69.
