Belhassen and Tovia-Brodie commented on our study on malignant Purkinje ectopy after
ajmaline or flecainide infusion in a cohort of patients with different ventricular
arrhythmias. By making reference to Julius Caesar (The Gospels), they mention the omission of a case report by Tsuchiya et al showing polymorphic
and monomorphic ventricular tachycardia induced by pilsicainide, another sodium channel
blocker. Noteworthy, individual cases using doxepin (inhibitor of HERG channel), lidocaine
(sodium channel blocker), atropine, isoproterenol, or electrolytic disturbance (hypokalemia)
have also been reported earlier,
1
,
2
,
3
and here we mentioned a case induced by propofol used during anesthesia. Purkinje
ectopy can also be favored by the presence of structural heart disease that facilitates
the induction of triggered activity, which is the probable mechanism of this arrhythmia
(ie Purkinje ectopy).
3
,4
The study by Nagai et al, quoted by Belhassen, reports a reentrant ventricular tachycardia
that is relevant to another (conductive) Purkinje-related mechanism. The reference
Steinberg et al (2021) was quoted in our article.To read this article in full you will need to make a payment
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References
- Doxepin induced torsade de pointes.Pacing Clin Electrophysiol. 1982; 5: 873-877
- Torsade de pointes à couplage court compliquée d'une mort subite.Tunis Méd. 2004; 82: 542-545
- Short-coupled variant of torsade de pointes: a new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias.Circulation. 1994; 89: 206-215
- Ventricular arrhythmias and the His-Purkinje system.Nat Rev Cardiol. 2016; 13: 155-166
Article info
Publication history
Published online: August 20, 2022
Footnotes
Funding Sources: The authors have no funding sources to disclose.
Disclosures: The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Heart Rhythm Society.
ScienceDirect
Access this article on ScienceDirectLinked Article
- To the Editor—Give to Caesar what belongs to CaesarHeart RhythmVol. 19Issue 11
- PreviewEscande et al1 recently reported the rare but reproducible occurrence of short-coupled premature ventricular complexes after the administration of sodium channel blockers (ajmaline or flecainide) in patients with suspected or documented severe idiopathic ventricular arrhythmias. These arrhythmias mostly originated from the Purkinje tissue and could be treated by ablation.
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