Abstract
BackgroundSeveral types of antiarrhythmic drugs are known to induce QT prolongation and torsades de pointes.Case presentationAn 84-year-old man was scheduled for open gastrectomy for residual cancer. He had been prescribed bepridil for atrial fibrillation that converted to sinus rhythm with prolonged QT interval in the operating room. After the surgery was initiated under general and epidural anesthesia, the patient’s heart rate decreased to 50/min and multifocal premature ventricular contractions appeared, followed by several episodes of torsades de pointes, each lasting for 5 to 15 s. Infusion of isoproterenol was started (0.01 μg/kg/min), and the heart rate was maintained at around 80/min. Premature ventricular contractions disappeared, and torsades de pointes did not recur during the surgery. The operation was completed uneventfully. The serum bepridil concentration was found to be extremely high postoperatively.ConclusionsBepridil-induced intraoperative episodes of torsades de pointes were successfully treated by increasing the heart rate with isoproterenol.
Highlights
Several types of antiarrhythmic drugs are known to induce QT prolongation and torsades de pointes.Case presentation: An 84-year-old man was scheduled for open gastrectomy for residual cancer
Bepridil-induced intraoperative episodes of torsades de pointes were successfully treated by increasing the heart rate with isoproterenol
We report a case of intraoperative QT prolongation and torsades de pointes (TdP) in a patient on bepridil
Summary
Apart from congenital causes, long QT syndrome can be secondary to several medications including antiarrhythmics known to induce QT prolongation and torsades de pointes (TdP), termed the acquired long QT syndrome. An 84-year-old male was scheduled for open gastrectomy for residual cancer He was prescribed with bepridil (200 mg/day) and edoxaban (60 mg/day) for AF. Echocardiography revealed an ejection fraction of 57% without wall motion abnormalities On admission to the operating room, ECG revealed normal SR with a HR of 72/min and QT/QTc interval. Isoproterenol (0.01 μg/kg/min) was started to increase the HR and counteract the QT-prolonging effect of bradycardia. A few minutes after the start of isoproterenol, once the HR increased to 80/min, PVCs, short runs, and TdP disappeared and were not observed thereafter (Fig. 1e). AF again converted to SR with a HR of 89/min and QT/ QTc interval of 440/538 ms. The serum concentrations of bepridil on the second and third postoperative days (2341 and 2415 ng/mL, respectively) were found to be remarkably high with respect to the reported therapeutic range (250–800 ng/mL) [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
