A REVIEW OF ERYTHROMYCIN-INDUCED MALIGNANT TACHYARRHYTHMIA - TORSADE-DE-POINTES - A CASE-REPORT

The term torsade de pointes refers to a ventricular tachycardia charac terized by QRS complexes of changing amplitude that appears to twist a round the isoelectric line and occurs at rates of 200-250/minute. Most cases of torsade de pointes are iatrogenically induced by drugs or el ectrolyte abnormalities. The most important feature is QT interval pro longation. Torsade de pointes was first described in 1966 in France by Dessertenne. The authors report a case of a fifty-year-old woman with medical history of corrective surgery for tetralogy of Fallot who was admitted to the hospital with pneumonia and atrial fibrillation and l ater developed recurrent episodes of polymorphic ventricular tachycard ia with QT interval prolongation after IV administration of erythromyc in. The episodes did not recur after discontinuation of erythromycin, and the QT interval returned to normal. The association of erythromyci n with torsade de pointes has been reported in 18 cases to date. Eryth romycin has been shown to produce electrophysiologic effects similar t o those of class Ia and class III antiarrhythmic drugs on the cardiac muscle. This potentially fatal complication of a commonly used antibio tic is rare, but increased physician awareness is important, especiall y in patients with predisposing factors like electrolytes abnormalitie s, use of class Ia and Class III antiarrhythmic drugs, and presence of prolonged QT interval (congenital prolonged QT syndromes). This is th e second case reported in a patient with previous cardiac surgery and erythromycin administration.