Images in Clinical Medicine
Digoxin-Induced Bidirectional Ventricular Tachycardia
N Engl J Med 1997; 336:550February 20, 1997
- Article
Figure 1 A 71-year-old woman had recently undergone mitral-valve replacement after being treated with digoxin for 12 years for atrial fibrillation. After the operation, the same dose of digoxin was administered intravenously, despite rising creatinine levels. The 12-lead electrocardiogram in Panel A shows an alternating QRS axis that is characteristic of bidirectional ventricular tachycardia (arrows), an arrhythmia virtually diagnostic of digitalis toxicity. The serum digoxin level at the time of the electrocardiogram was 4.5 ng per milliliter (normal, 0.8 to 2.0). The tracing in Panel B, obtained after treatment with digoxin monoclonal antibody, shows resolution of the bidirectional ventricular tachycardia, with the patient's base-line rhythm of atrial fibrillation. There is a tendency for the rhythm to regularize that in itself is a common finding in digitalis toxicity. No symptoms were reported, because the patient was intubated and sedated during these events.
Scott Valent, M.D.
Patricia Kelly, M.D.
University of Colorado Health Sciences Center, Denver, CO 80262- Citing Articles (3)
Citing Articles
1
Alex A. Baher, Matthew Uy, Fagen Xie, Alan Garfinkel, Zhilin Qu, James N. Weiss. (2011) Bidirectional ventricular tachycardia: Ping pong in the His–Purkinje system. Heart Rhythm 8:4, 599-605
CrossRef2
Jason D Roberts, Michael H Gollob. (2010) The genetic and clinical features of cardiac channelopathies. Future Cardiology 6:4, 491-506
CrossRef3
Manuel J. Menduiña, José M. Candel, Pilar Alaminos, Francisco J. Gómez, José Vílcheza. (2005) Taquicardia ventricular bidireccional por intoxicación digitálica. Revista Española de Cardiología 58:8, 991-993
CrossRef
