Procainamide-induced torsade de pointes in a patient with WPW syndrome.
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A case of torsade de pointes (Tdp) caused by class Ia antiarrhythmic drugs is reported. The patient was a 73-year-old woman with WPW syndrome and hypothyroidism. She had been treated with disopyramide (450mg/day) for 6 months because of paroxysmal supraventricular tachycardia (PSVT), but it was not controlled. A large amount of procainamide (1, 400mg) was added, which caused marked prolongation of the QT interval (QTc=0.67sec) and Tdp. Sustained ventricular tachycardia and shock developed. On admission, electrocardiogram showed ventricular tachycardia, which was treated by DC shock and drip infusion of lidocain and verapamil. But since PSVT reccured frequently, catheter ablation was performed successfully. Class Ia drugs are effective for PSVT in the WPW syndrome patient, but cause prolongation of the QT interval and Tdp. If ordinary doses of these drugs are not effective, surgical treatment should be considered.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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