Oral quinine sulfate for the treatment of electrical storm and prevention of recurrent shocks in Brugada syndrome after failed cilostazol therapy Jayaprakash.

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Presentation transcript:

Oral quinine sulfate for the treatment of electrical storm and prevention of recurrent shocks in Brugada syndrome after failed cilostazol therapy Jayaprakash Shenthar, MD, FACC, FRCP (Lond), Siva Sankara Chakali, MD, Debashish Acharya, MD, Javed Parvez, MD, Bharatraj Banavalikar, MD HeartRhythm Case Reports Volume 3, Issue 10, Pages 470-474 (October 2017) DOI: 10.1016/j.hrcr.2017.07.005 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Details of implantable cardioverter-defibrillator (ICD) interrogation at the time of presentation. A: The log of therapies delivered by the ICD reveals that from 16.06 to 17.07 hours the patient has 10 shocks delivered for ventricular fibrillation (VF). B: Intracardiac electrogram of 1 of the above episodes from the device shows a ventricular ectopic beat falling on the T wave, initiating a polymorphic ventricular tachycardia (VT) degenerating into VF correctly identified by the device. The patient received an appropriate therapy with a 35-joule shock terminating the VF (not in the picture). HeartRhythm Case Reports 2017 3, 470-474DOI: (10.1016/j.hrcr.2017.07.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Interrogation data from the implantable cardioverter-defibrillator before the present episode while on oral cilostazol therapy after the first electrical storm (red block arrow). While on cilostazol, the patient had 1 electrical storm (blue arrowhead), 1 episode of ventricular fibrillation (VF, red star), 9 episodes of ventricular tachycardia (VT) not requiring therapy, and 17 episodes of superventricular tachycardia (SVT). HeartRhythm Case Reports 2017 3, 470-474DOI: (10.1016/j.hrcr.2017.07.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Twelve-lead electrocardiograms (ECGs) of the patient. A: ECG at presentation has type 1 Brugada pattern with marked ST elevation seen in V1 to V3. B: ECG done 14 hours after initiation of isoprenaline infusion shows persistent type 1 Brugada pattern but with the resolution of ST segment. Ventricular ectopic beat is also noted. C: ECG on follow-up while on quinine therapy shows incomplete right bundle branch block pattern with complete resolution of ST segment. HeartRhythm Case Reports 2017 3, 470-474DOI: (10.1016/j.hrcr.2017.07.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions