WPW Induced Ventricular Tachycardia in a Patient Using Quetiapine

Abstract

Abstract Ventricular tachycardia (VT) is a mortal rhythm that can occur for many reasons. Wolff Parkinson White (WPW) syndrome can cause VT. Although there are usually signs and symptoms specific to underlying diseases, sometimes it may not be possible to make a differential diagnosis. A 32-year-old male presented to the emergency department with complaints of sudden onset of palpitations and weakness. He was using quetiapine in history. His hemodynamic were stable and his rhythm on the electrocardiogram (ECG) was evaluated as VT. Medical cardioversion was started with amiodarone. Electrical cardioversion was performed after the development of nausea, dizziness, and chest pain symptoms, and a return to normal sinus rhythm was achieved. There were no typical findings in the control ECG showing WPW syndrome or the effect of Quetiapine. The diagnosis of WPW was confirmed by an electrophysiological study (EPS), and successful treatment was performed by catheter ablation. Early electrical cardioversion may be considered when there is no response to medical cardioversion in the acute treatment of VT. Earlier application of specific treatment procedures such as EPS may be considered for differential diagnosis and curative treatment.

Keywords

• Emergency
• Electrophysiological study (EPS)
• Quetiapine
• Catheter ablation
• Ventricular Tachycardia
• Wolff Parkinson White (WPW)

Ketiapin Kullanan bir Hastada WPW Nedenli Ventriküler Taşikardi

Abstract

Özet Ventriküler taşikardi (VT) birçok neden ile oluşabilen ölümcül bir ritimdir. Wolff Parkinson White (WPW) sendromu VT’ye neden olabilmektedir. Genellikle altta yatan hastalıklara spesifik belirti ve bulgular bulunsa da bazen ayırıcı tanı yapabilmek mümkün olmayabilir. Otuz iki yaşında erkek ani başlayan çarpıntı ve halsizlik şikâyeti ile acile başvurdu. Öyküde ketiapin kullandığı öğrenildi. Fizik bakıda hemodinamisi stabil ve elektrokardiyogramındaki (EKG) ritim VT olarak değerlendirildi. Amiodaron ile medikal kardiyoversiyona başlandı. Takiplerinde bulantı, baş dönmesi ve göğüs ağrısı semptomlarının gelişmesi sonucunda elektriksel kardiyoversiyon uygulanarak normal sinüs ritmine dönüş sağlandı. Kontrol EKG’sinde WPW sendromunu ya da Ketiapin etkisini gösteren tipik bulgular mevcut değildi. Elektrofizyolojik çalışma (EPS) ile WPW tanısı kesinleştirilen hastaya kateter ablasyonu ile başarılı tedavi uygulandı. Ventriküler taşikardi için uygulanan akut medikal tedavi protokollerine yanıt alınamadığı durumlarda elektriksel kardiyoversiyon ön planda düşünülebilir. Ayırıcı tanı ve küratif tedavi için EPS gibi spesifik tedavi prosedürlerinin daha erken uygulanması göz önünde bulundurulabilir.

Keywords

• Acil
• Elektrofizyolojik çalışma (EPS)
• Ketiapin
• Kateter ablasyonu
• Ventriküler Taşikardi
• Wolff Parkinson White (WPW)

References

1. Almas A, Hameed K, Hameed A. Ventricular tachycardia: a hospital perspective. J Coll Physicians Surg Pak. 2005 Feb;15(2):68-70. PMID: 15730827.
2. Roberts-Thomson KC, Lau DH, Sanders P. The diagnosis and management of ventricular arrhythmias. Nat Rev Cardiol. 2011 Jun;8(6):311-21. doi: 10.1038/nrcardio.2011.15.
3. Brunckhorst C, Delacretaz E. Kammertachykardien--Atiologie, Mechanismen, Therapie [Ventricular tachycardia--etiology, mechanisms and therapy]. Ther Umsch. 2004 Apr;61(4):257-64. German. doi: 10.1024/0040-5930.61.4.257.
4. Lo R, Chia KK, Hsia HH. Ventricular Tachycardia in Ischemic Heart Disease. Card Electrophysiol Clin. 2017 Mar;9(1):25-46. doi: 10.1016/j.ccep.2016.10.013.
5. Saliba WI, Natale A. Ventricular tachycardia syndromes. Med Clin North Am. 2001 Mar;85(2):267-304. doi: 10.1016/s0025-7125(05)70316-3. PMID: 11233949.
6. AlMahameed ST, Ziv O. Ventricular Arrhythmias. Med Clin North Am. 2019 Sep;103(5):881-895. doi: 10.1016/j.mcna.2019.05.008.
7. Hasnain M, Vieweg WV, Howland RH, et al. Quetiapine, QTc interval prolongation, and torsade de pointes: a review of case reports. Ther Adv Psychopharmacol. 2014;4(3):130-138. doi:10.1177/2045125313510194
8. De Hert M, Detraux J, van Winkel R, Yu W, Correll CU. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nat Rev Endocrinol. 2011 Oct 18;8(2):114-26. doi: 10.1038/nrendo.2011.156.

9. Mohan S, Balaji S. Management of asymptomatic ventricular preexcitation. Indian Pacing Electrophysiol J. 2019 Nov-Dec;19(6):232-239. doi: 10.1016/j.ipej.2019.10.001.
10. Silvia G Priori, Carina Blomström-Lundqvist, Andrea Mazzanti, Nico Blom, Martin Borggrefe, John Camm, et al. ESC Scientific Document Group, 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC), European Heart Journal, Volume 36, Issue 41, 1 November 2015, Pages 2793–2867, https://doi.org/10.1093/eurheartj/ehv316
11. Chhabra L, Goyal A, Benham MD. Wolff Parkinson White Syndrome. 2020 Aug 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32119324.
12. Tan HH, Hoppe J, Heard K. A systematic review of cardiovascular effects after atypical antipsychotic medication overdose. Am J Emerg Med. 2009 Jun;27(5):607-16. doi: 10.1016/j.ajem.2008.04.020.