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KMID : 1140520200240030155
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Korean Journal of Emergency Medical Services
2020 Volume.24 No. 3 p.155 ~ p.160
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Case report : Administration of amiodarone for polymorphic ventricular tachycardia due to long QT syndrome during out-of-hospital advanced cardiac life support
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Kang Min-Seong
Kim Ji-Won
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Abstract
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Torsades de pointes refers to polymorphic ventricular tachycardia (PMVT), which is caused by the suppression of potassium channels owing to genetic and electrolytic abnormalities, resulting in the extension of the QT interval. Symptoms range from spontaneous circulation recovery to fainting and sudden death. Defibrillation, magnesium correction, and the use of lidocaine as an antiarrhythmic agent are recommended as treatments for persistent torsades de pointes. Currently, only amiodarone is available in the ambulance; however, torsades de pointes does not respond efficiently to amiodarone because it suppresses potassium channels and increases the refractory period of the myocardium. Lidocaine, in contrast, reduces the relative refractory period of the myocardium caused by suppressing sodium channels; thus, it inhibits the occurrence of and treats arrhythmia. In cases where PMVT did not respond to defibrillation, the administration of lidocaine showed no difference in survival and discharge rates compared to amiodarone. Thus, ambulances must be equipped with provisions to administer lidocaine.
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KEYWORD
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SALS, Torsades de Pointes, Cardiac arrest, Amiodarone, Long QT syndrome
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