Atropine-induced non-sustained polymorphic ventricular tachycardia: A rare case

Öz

A 40 years old male with history of unexplained recurrent presyncope and palpitation episodes referred to cardiology department. Patient had no past medical history. Subsequently, electrophysiology study was performed to detect any underlying atrioventricular nodal disease or inducible tachyarrhythmias. During this period, 1.0 mg of atropine was injected intravenously to performed stimulation and patient suddenly developed polymorphic ventricular tachycardia that could not be terminated with overdrive pacing. Ventricular tachycardia was terminated spontaneously, two minutes later. J Clin Exp Invest 2014; 5 (3): 449-451

Anahtar Kelimeler

• ventricular tachycardia, atropine, presyncope

Nadir bir olgu: Atropinin indüklediği sürekli olmayan polimorfik ventriküler taşikardi

Öz

Tekrarlayan çarpıntı ve presenkop şikayetleri ile 40 yaşında erkek hasta kardiyoloji kliniğine başvurdu. Hastanın öz geçmişinde herhangi bir özellik yoktu. Atriyoventriküler nod hastalığı veya taşiaritmi indüklemek için elektrofizyolojik çalışma yapıldı. Atropin 1.0 mg yapıldıktan sonra testin tekrarlanması planlandı. Bu esnada polimorfik ventriküler taşikardi gelişti. Overdrive pacing ile taşikardi sonlanmadı yaklaşık 2 dakika sonra spontan olarak sonlandı.

Anahtar Kelimeler

• ventriküler taşikardi, atropin, presenkop

Kaynakça

1. Fei L, Statters DJ, Hnatkova K, et al. Change of auto- nomic influence on the heart immediately before the onset of spontaneous idiopathic ventricular tachycar- dia. J Am Coll Cardiol 1994;24:1515-1522.
2. Wu W, Lu Z. Loss anti-arrhytmic effect of vagal nerve stimulation on ischemia-induced ventricular tachyar- rhytmia in aged rats. Tohoku J Exp Med 2011:223;27- 33.
3. Massumi RA, Mason DT, Amsterdam EA, et al. Ven- tricular fibrillation and tachycardia after intravenous atropine for treatment of bradycardias. N Engl J Med 1972;287:336-338.
4. Goel VK, Mehrotra TN, Gupta SK. Ventricular tachyar- rhythmias: complication of atropine therapy in acute myocardial infarction. Indian Heart J 1981;33:301- 302.
5. La Rovere MT, Bigger JT Jr, Marcus FI, et al. Baroreflex sensitivity and heart-rate variability in prediction of to- tal cardiac mortality after myocardial infarction. ATRA- MI (Autonomic Tone and Reflaxes After Myocardial Infarction) Investigators. Lancet 1998;351:478-484.
6. Ando M, Katare RG, Kakinuma Y, et al. Efferent vagal nerve stimulation protects heart against ischemia-in- duced arrhytmias by preserving connextin43 protein. Circulation 2005:112;164-170.
7. Averill KH, Lamb LE. Less commonly recognized ac- tions of atropine on cardiac rhythm. Am J Med Sci 1959;237:304-318.
8. Coumel P, Rosengarten MD, Leclercq JF, Attuel P. Role of sympathetic nervous system in non-ischaemic ven- tricular arrhythmias. Br Heart J 1982;47:137-147.

9. Zipes DP, Knoebel SB. Rapid rate-dependent ventricu- lar ectopy: adverse response to atropine induced rate increase. Chest 1972;62:255-258.
10. Berkowitz WD, Young MW, Scherlage BJ, et al. Rate dependency of cardiac glycoside action on atrioven- tricular (AV) conduction and ventricular automaticity. Clin Res 1968;16:222.