Abstract
Leuprolide acetate is a synthetic nonpeptide analog that is a potent gonadotropin-releasing hormone receptor agonist. It is used in diverse clinical applications, including treatment for prostate cancer, endometriosis, and uterine fibroids as well as the in vitro fertilization technique. Prolonged QT interval leading to torsades de pointes (TdP) is one of the very rare side effects of leuprolide therapy. Herein, we report a 68-year-old male patient with a history of prostate cancer post-radiation and on androgen suppression therapy with leuprolide who suffered from out-of-hospital cardiac arrest. After initial resuscitation, the patient’s electrocardiogram (ECG) showed a prolonged corrected QT interval (QTc), which subsequently progressed into a TdP rhythm, requiring lidocaine drip initially. The patient’s symptoms improved, and his ECG rhythm was resolved after initiating mexiletine and propranolol treatment with no recurrent TdP episodes after discontinuation of leuprolide.
Highlights
Torsades de pointes (TdP) arrhythmia is a potentially life-threatening clinical condition that occurs as a complication of a prolonged QT interval [1]
TdP is a potentially lethal ventricular dysrhythmia resulting from a complication of a prolonged QT interval [1]
It is difficult to measure TdP mortality, as an ECG showing TdP arrhythmia may not be available during sudden cardiac death
Summary
Torsades de pointes (TdP) arrhythmia is a potentially life-threatening clinical condition that occurs as a complication of a prolonged QT interval [1]. The patient was treated with lupron (leuprolide) depot (30 mg every four months) His ECG three months prior to the event showed a ventricular paced rhythm with a QTc of 498 ms and an ECG QSR duration of 177 ms (Figure 4). The patient’s medications included flomax (tamsulosin; 0.4 mg), coumadin (7.5 mg), lipitor (10 mg), valsartan/hydrochlorothiazide (160 mg/12.5 mg), and lupron (leuprolide; 30 mg) He did not have any family history of long QT syndrome (LQTS) and had not previously suffered from ventricular tachycardia events. In the six-month follow-up visit, the patient revealed that he had not suffered from any further episodes of ventricular tachycardia or ventricular fibrillation His ECG showed an improvement in the QTc duration, which had reduced to 484 ms (Figure 5).
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