病例报告：胺碘酮在先前存在QT间期延长的败血症心肌病中引发难治性心室颤动风暴：使用利多卡因和山莨菪碱终止
Case Report: Amiodarone-triggered refractory ventricular fibrillation storm in septic cardiomyopathy with pre-existing QT prolongation: termination using lidocaine and anisodamine.
摘要(中文译文)
脓毒性心肌病（SCM）是由脓毒症引起的可逆性急性心功能障碍。使用莫西沙星和胺碘酮等延长QT间期的药物可能诱发危及生命的心律失常，包括尖端扭转型室性心动过速（TdP）和心室颤动（VF），二者均与高发病率和死亡率相关，给临床管理带来重大挑战。我们报告一例89岁男性患者，继发于肠源性脓毒性休克的脓毒性心肌病，表现为校正QT（QTc）间期显著延长及心功能受损。静脉给予莫西沙星和胺碘酮后，QTc间期进一步延长，导致频发室性期前收缩，并进展为难治性TdP和VF。尽管采取了包括纠正电解质、除颤和心肺复苏在内的常规治疗，心律失常仍无法控制。开始给予利多卡因联合山莨菪碱静脉维持治疗，心律失常逐渐缓解。未再发生TdP或VF发作。2周后左心室功能恢复至基线水平，患者病情稳定出院。9个月随访显示心功能接近完全恢复。莫西沙星和胺碘酮可能在脓毒性心肌病患者中诱发难治性TdP和VF。利多卡因联合山莨菪碱静脉给药可能是终止此类难治性心律失常的一种潜在治疗选择。
Abstract
Septic cardiomyopathy (SCM) is a reversible acute cardiac dysfunction caused by sepsis. The use of QT-prolonging agents such as moxifloxacin and amiodarone may induce life-threatening arrhythmias, including torsades de pointes (TdP) and ventricular fibrillation (VF), both associated with high morbidity and mortality, posing significant challenges in clinical management. We report the case of an 89-year-old male who developed septic cardiomyopathy secondary to enterogenic septic shock, presenting with marked corrected QT (QTc) prolongation and impaired cardiac function. Following intravenous administration of moxifloxacin and amiodarone, QTc interval further prolonged, leading to frequent premature ventricular contractions that progressed to refractory TdP and VF. Despite conventional treatment, including electrolyte correction, defibrillation, and cardiopulmonary resuscitation, the arrhythmias remained uncontrollable. Intravenous maintenance therapy with lidocaine combined with anisodamine was initiated, resulting in gradual resolution of arrhythmias. No further TdP or VF episodes occurred. After 2 weeks, left ventricular function returned to baseline, and the patient was discharged in stable condition. A 9-month follow-up revealed near-complete recovery of cardiac function. Moxifloxacin and amiodarone may trigger refractory TdP and VF in patients with septic cardiomyopathy. Intravenous lidocaine combined with anisodamine may be a potential therapeutic option for terminating these refractory arrhythmias.
如何引用
AMA
Min Wu, Lutao Xie, Pin Lan, Meisong Chen. Case Report: Amiodarone-triggered refractory ventricular fibrillation storm in septic cardiomyopathy with pre-existing QT prolongation: termination using lidocaine and anisodamine.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1841318.
APA
Min Wu, Lutao Xie, Pin Lan, Meisong Chen (2026). Case Report: Amiodarone-triggered refractory ventricular fibrillation storm in septic cardiomyopathy with pre-existing QT prolongation: termination using lidocaine and anisodamine.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1841318
GB/T 7714
Min Wu, Lutao Xie, Pin Lan, Meisong Chen. Case Report: Amiodarone-triggered refractory ventricular fibrillation storm in septic cardiomyopathy with pre-existing QT prolongation: termination using lidocaine and anisodamine.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1841318.
在 PubMed增强版 阅读全文
翻译全文 · AI 文献问答 · PDF 原文下载 · 引用导出