Sequeira Orlando Robert, Aquino Nelson Javier, Gómez Nancy Beatriz, García Laura Beatriz, Cáceres Cristina, Lovera Oscar A, Centurión Osmar Antonio
Department of Health Sciences's Investigation. Sanatorio Metropolitano. Fernando de la Mora. Paraguay. Cardiology Department, Clinic Hospital, Asunción National University, San Lorenzo, Paraguay.
J Atr Fibrillation. 2016 Oct 31;9(3):1502. doi: 10.4022/jafib.1502. eCollection 2016 Oct-Nov.
Amiodarone is still the most potent antiarrhythmic drug in the prevention of life threatening ventricular arrhythmias and demonstrates a very low incidence of torsade de pointes. An unusual case of an 81-year-old woman who developed serious abnormalities of the conduction system of the heart and torsade des pointes during intravenous infusion of amiodarone for the treatment of paroxysmal atrial fibrillation is described. To the best of our knowledge, this is the first case showing an association of intravenous amiodarone-induced third degree atrioventricular block and extreme QT interval prolongation generating torsade des pointes in a patient with paroxysmal atrial fibrillation who required an implantable cardioverter-defibrillator. Currently, amiodarone is still one of the few remaining treatment options for the medical therapeutic management of serious ventricular arrhythmias and to reduce the incidence of atrial fibrillation without increasing mortality or sudden cardiac death rates in heart failure patients like our elderly present patient. Nevertheless, we have to keep in mind that intravenous amiodarone may generate serious abnormalities of the conduction system of the heart and lethal ventricular arrhythmias in certain patients.
胺碘酮仍是预防危及生命的室性心律失常最有效的抗心律失常药物，且尖端扭转型室速的发生率极低。本文描述了一例81岁女性的罕见病例，该患者在静脉输注胺碘酮治疗阵发性心房颤动期间出现心脏传导系统严重异常及尖端扭转型室速。据我们所知，这是首例显示静脉注射胺碘酮诱发三度房室传导阻滞并导致QT间期极度延长，进而在一名需要植入式心脏复律除颤器的阵发性心房颤动患者中引发尖端扭转型室速的病例。目前，胺碘酮仍是少数几种用于严重室性心律失常药物治疗管理及降低心房颤动发生率且不增加心力衰竭患者（如我们目前这位老年患者）死亡率或心源性猝死率的治疗选择之一。然而，我们必须牢记，静脉注射胺碘酮可能会在某些患者中引发心脏传导系统严重异常及致命性室性心律失常。
