Livstruende, repetitiv arytmi hos patienter i höjdosis methadonbehandling: torsade de pointes
Engelsk titel: Life-threatening, recurrent arrhythmia in patients on high-dose methadone treatment: torsade de pointes
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Författare:
Al-Shakarshi JS
;
Bent-Hansen L
;
Boje Jensen G
Email: lasse.bent.hansen@hh.hosp.dk
Språk: Dan
Antal referenser: 5
Dokumenttyp:
Fallbeskrivning
UI-nummer: 04081018
Sammanfattning
Torsade de pointes (TDP) ventricular tachycardia is a malignant arrhythmia related to long QT interval. The acquired form is usually associated with electrolyte disturbances such as hypokalemia or the use of certain drugs. We report five cases of fatal or near-fatal TDP in former opiate addicts receiving high-dose methadone substitution. At admission, all but one had varying degrees of hypokalemia and long QT (QTc > 500 ms). Echocardiography was normal. Each attack was preceded by increasing ectopic ventricular activity in the form of ventricular extrasystoles, eventually eliciting overt TDP by the R-on-T mechanism. High-dose lidocaine bolus had a short-term effect, but potassium infusion, amiodarone and beta-blockers had no effect. In all non-fatal cases, a stable heart rhythm was restored by temporary or permanent ventricular pacing at a rate of 90-100 Until more is known about the arrythmogenic potential of methadone, patients receiving this treatment should be controlled including QT/ECG measurements to seek out high-risk individuals.