Symptomatic Bradycardia

Kawji, Mazen M.

doi:10.1001/jamainternmed.2022.3674

Cited by 2 publications

(6 citation statements)

References 4 publications

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“…To the Editor We read with great interest a recent case report by Kawji. 1 It reports of a patient with bidirectional ventricular tachycardia (BVT) induced by cocaine use and mentions electrical cardioversion as a last resort, which we find is inappropriate.…”

Section: Unusual Tachycardia After Cocaine Usementioning

confidence: 99%

“…In Reply I thank Lin and He for their interest in my case report. 1 Most of their points were already addressed in detail, however. Determining the cause of bidirectional ventricular tachycardia (BVT) was clearly addressed when I stated that "treatment of BVT should consider the cause of the arrhythmia."…”

Section: Unusual Tachycardia After Cocaine Usementioning

confidence: 99%

“…Determining the cause of bidirectional ventricular tachycardia (BVT) was clearly addressed when I stated that "treatment of BVT should consider the cause of the arrhythmia." 1 Gastric lavage for treatment of aconitine ingestion was also mentioned.…”

Section: Unusual Tachycardia After Cocaine Usementioning

confidence: 99%

“…Cardioversion is the last resort." 1 Lin and He took that last sentence of the case report out of context. Electrical cardioversion is effective in terminating BVT.…”

Section: Unusual Tachycardia After Cocaine Usementioning

confidence: 99%

“…However, when we received a request to share our study data, 1 we realized that a number of inadvertent transcription and transposition errors had occurred in our response to peer review. These errors were primarily introduced by migrating back and forth between the intention-to-treat and intentionto-treat infected populations for the requested sensitivity analyses; "no hospitalization" and "total population" being transposed in a spreadsheet; and use of different parameters in creating forest plots with the counts as "yes/no" in the latter version vs "yes/total" during drafting.…”

Section: Corrections To a Meta-analysis Of Oseltamivir Use In Prevent...mentioning

confidence: 99%

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Unusual Tachycardia After Cocaine Use

Lin,

2024

JAMA Intern Med

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To the Editor We read with great interest a recent case report by Kawji. 1 It reports of a patient with bidirectional ventricular tachycardia (BVT) induced by cocaine use and mentions electrical cardioversion as a last resort, which we find is inappropriate.Treatment of BVT must first determine its cause. The causes of BVT are divided into toxic and nontoxic. Digoxin intoxication is the most common cause of BVT, but digoxin intoxication is not amenable to cardioversion because it produces calcium overload, which induces delayed after depolarization (DAD). Other causes, including aconite, cocaine, and caffeine intoxication, are all caused by DAD, although the ion imbalance between Na + , K + , and Ca 2+ is different.When BVT is suspected to be an acute phase transition caused by drugs, supportive treatments, such as gastric lavage, gastrointestinal decompression, and continuous kidney replacement therapy, are required to allow the body to excrete toxic alkaloids. In addition, for hemodynamically stable patients, Na + channel blockers can be used according to the mechanism of aconitine-induced arrhythmia; mexiletine, flecainide, and amiodarone may also be effective.Electrical cardioversion may be an alternative treatment for BVT when other antiarrhythmic drugs are ineffective; however, previous experience has shown that cardioversion is rarely effective. 2 When the patient is hemodynamically unstable, direct current cardioversion should be preferred because it is a safer cardioversion method than antiarrhythmic drugs. Timely application of electrical cardioversion has been shown to terminate a variety of cardiac arrhythmias and is believed to work by synergistically activating inactive voltagedependent sodium channels, thereby terminating automaticity. A growing number of case reports and clinical reviews of intoxicated BVT demonstrate limited effectiveness of electrical cardioversion for BVT. 3 This disappointing performance may

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Section: Unusual Tachycardia After Cocaine Usementioning

confidence: 99%

Section: Unusual Tachycardia After Cocaine Usementioning

confidence: 99%

Section: Unusual Tachycardia After Cocaine Usementioning

confidence: 99%

“…Cardioversion is the last resort." 1 Lin and He took that last sentence of the case report out of context. Electrical cardioversion is effective in terminating BVT.…”

Section: Unusual Tachycardia After Cocaine Usementioning

confidence: 99%

Section: Corrections To a Meta-analysis Of Oseltamivir Use In Prevent...mentioning

confidence: 99%

See 3 more Smart Citations