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Reply to the Editor— Give to Caesar what belongs to Caesar

  • Michel Haissaguerre
    Affiliations
    Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France

    CHU Bordeaux, Service de Cardiologie – Electrophysiologie et Stimulation cardiaque, Bordeaux, France

    IHU LIRYC, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, Pessac, France
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  • William Escande
    Affiliations
    CHU Bordeaux, Service de Cardiologie – Electrophysiologie et Stimulation cardiaque, Bordeaux, France

    IHU LIRYC, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, Pessac, France
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  • Jean-Baptiste Gourraud
    Affiliations
    L’Institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France

    CHU Nantes, Service de génétique médicale, Nantes, France
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  • Olivier Bernus
    Affiliations
    Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France

    IHU LIRYC, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, Pessac, France
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  • Frédéric Sacher
    Affiliations
    Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France

    CHU Bordeaux, Service de Cardiologie – Electrophysiologie et Stimulation cardiaque, Bordeaux, France

    IHU LIRYC, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, Pessac, France
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  • on behalf of all authors
Published:August 20, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.08.017
      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,
      • Strasberg B.
      • Coelho A.
      • Welch W.
      • Swiryn S.
      • Bauernfeind R.
      • Rosen K.
      Doxepin induced torsade de pointes.
      • Hentati M.
      • Krichene S.
      • Kechida Z.
      • et al.
      Torsade de pointes à couplage court compliquée d'une mort subite.
      • Leenhardt A.
      • Glaser E.
      • Burguera M.
      • Nürnberg M.
      • Maison-Blanche P.
      • Coumel P.
      Short-coupled variant of torsade de pointes: a new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias.
      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).
      • Leenhardt A.
      • Glaser E.
      • Burguera M.
      • Nürnberg M.
      • Maison-Blanche P.
      • Coumel P.
      Short-coupled variant of torsade de pointes: a new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias.
      ,
      • Haissaguerre M.
      • Vigmond E.
      • Stuyvers B.
      • Hocini M.
      • Bernus O.
      Ventricular arrhythmias and the His-Purkinje system.
      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.
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      References

        • Strasberg B.
        • Coelho A.
        • Welch W.
        • Swiryn S.
        • Bauernfeind R.
        • Rosen K.
        Doxepin induced torsade de pointes.
        Pacing Clin Electrophysiol. 1982; 5: 873-877
        • Hentati M.
        • Krichene S.
        • Kechida Z.
        • et al.
        Torsade de pointes à couplage court compliquée d'une mort subite.
        Tunis Méd. 2004; 82: 542-545
        • Leenhardt A.
        • Glaser E.
        • Burguera M.
        • Nürnberg M.
        • Maison-Blanche P.
        • Coumel P.
        Short-coupled variant of torsade de pointes: a new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias.
        Circulation. 1994; 89: 206-215
        • Haissaguerre M.
        • Vigmond E.
        • Stuyvers B.
        • Hocini M.
        • Bernus O.
        Ventricular arrhythmias and the His-Purkinje system.
        Nat Rev Cardiol. 2016; 13: 155-166

      Linked Article

      • To the Editor—Give to Caesar what belongs to Caesar
        Heart RhythmVol. 19Issue 11
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          Escande 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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