TORSADE-DE-POINTES TACHYCARDIA UNDER COMB INATION OF QUIDINE AND VERAPAMIL IN ATRIAL-FIBRILLATION

The following case report shows that life threatening arrhythmias with fatal consequences may occur after treatment with Cordichin(R) a comb ination of 80 mg verapamil and 160 mg quinidine. A 65-year-old woman w as treated with Cordichin(R) due to atrial fibrillation lasting for 3 months. After the first day of treatment the patient suddenly collapse d with loss of consciousness. The patient was resuscitated 15 min late r. The emergency physician diagnosed a cardiac arrest. After cardiopul monary resuscitation and intubation stable circulation was restored. W hen the patient was admitted in our hospital the ECG showed numerous v entricular extrasystoles, marked prolongation of the QT interval (700 ms) (Figures la and b) and nonsustained polymorphic ventricular tachyc ardias(Figure 2). The arrhythmias could be suppressed by right ventric ular stimulation after inserting a pacemaker lead. After a period of 1 2 h a normal QT interval was restored (Figure 3). Unfortunately the pa tient died 3 days later due to irreversible cerebral damage. The conce pt of suppressing proarrhythmic effects of quinidine by calcium antago nists is discussed. Despite theoretical advantages of a combination th erapy this case report shows that life threatening dysrhythmias cannot be prevented by additional calcium antagonism.