METHOTREXATE-LINKED VENTRICULAR ARRHYTHMIAS

A 36-year-old male, who 1 year previously had survived a large anterio r myocardial infarction, followed by cardiac arrest, was treated a few months for psoriasis with oral methotrexate, at single weekly oral do ses of up to 10 mg, when he had to be hospitalized due to anginal pain and palpitation, Repeated 24-hour electrocardiogram recordings reveal ed ventricular ectopy up to 580 premature beats per hour. The ventricu lar premature beats were almost completely abolished after a few days' discontinuation of methotrexate therapy but recurred a few hours afte r an attempt to restart it had been made. A coronary angiogram showed only minimal wall abnormalities. Electrophysiological testing and endo myocardial biopsy were normal.