QTc prolongation and torsades de pointes due to a coadministration of fluoxetine and amiodarone in a patient with implantable cardioverter-defibrillator: Case report and review of the literature

Abstract

Rationale: Drug-induced prolongation of the corrected QT interval (QTc) may lead to serious and potentially life-threatening ventricular tachyarrhythmia, such as torsades de pointes (Tdp), which is worthy of clinical attention. Here, we report 1 case of Tdp after a coadministration of fluoxetine and amiodarone.

Patient concerns: A 62-year-old Chinese male who placed with the implanted cardioverter-defibrillator (ICD) appeared the QTc prolongation and Tdp after the concurrent administration of fluoxetine and amiodarone.

Diagnoses: Torsades de pointes (Tdp).

Interventions: The patient was treated with magnesium and potassium immediately. Her ICD-brady pacing mode was reprogrammed to 90 bpm. Meanwhile, both of fluoxetine and amiodarone were discontinued.

Outcomes: The further episodes of Tdp were prevented. After a few days, the QTc gradually decreased without clinically significant arrhythmias.

Lessons: The present case demonstrates that a potential drug-drug interaction (DDI) may lead to a life-threatening drug adverse reaction (ADR) especially in special subjects. Therefore, clinicians should closely monitor the electrocardiogram (ECG) when QTc-prolonging agents are given to patients with cardiac abnormalities, and avoid combining 2 QTc-prolonging drugs.

Figure 1

(A) ECG on admission (QTc = 386 ms); (B) ECG showing QT prolongation (QTc = 501 ms); (C) The continuous ECG monitoring an episode of Tdp; (D) The continuous ECG monitoring the lapse of Tdp. (E) ECG showing pacing rhythm reprogrammed to 90 bpm (QTc = 493 ms). (F) ECG showing pacing rhythm reprogrammed to 60 bpm on discharge (QTc = 446 ms).