QTc in the elderly

A 76-year-old woman was referred to our hospital for the evaluation of significant mitral regurgitation. She had a history of mastectomy for breast cancer, paroxysmal atrial fibrillation, treated with amiodarone (200  mg once daily), and non-vitamin-K-oral anticoagulation; and fibromyalgia, necessitating the chronic intake of duloxetine (tricyclic antidepressant). Because of insufficient paint relief, her general practitioner had associated pregabilin (150 mg twice daily) a couple of days before admission. A lmost immediately after presentation, she collapsed because of a ventricular-fibrillation-arrest, prompting two cycles of cardiopulmonary resuscitation, and one shock. The potassium post-arrest was low (2.8 mmol/L), calcium and magnesium were within the normal range. Her post-arrest electrocardiog ram (Panel) showed an extremely prolonged QT: 760  ms (QTc: 694 ms, rate 50 b.p.m., normal QRS-width) without evidence for acute ischaemia. After withholding the amiodarone and duloxetine, correcting the potassium levels, and weaning the pregabilin, the QTc-interval normalised (458 ms). Our patient recovered well and underwent an uncomplicate d MitraClip procedure.
Source: European Heart Journal - Category: Cardiology Source Type: research