[Torsade de pointes tachycardia during administration of quinidine and verapamil in atrial fibrillation].

The following case report shows that life threatening arrhythmias with fatal consequences may occur after treatment with Cordichin a combination of 80 mg verapamil and 160 mg quinidine. A 65-year-old woman was treated with Cordichin due to atrial fibrillation lasting for 3 months. After the first day of treatment the patient suddenly collapsed with loss of consciousness. The patient was resuscitated 15 min later. The emergency physician diagnosed a cardiac arrest. After cardiopulmonary resuscitation and intubation stable circulation was restored. When the patient was admitted in our hospital the ECG showed numerous ventricular extrasystoles, marked prolongation of the QT interval (700 ms) (Figures 1a and b) and nonsustained polymorphic ventricular tachycardias (Figure 2). The arrhythmias could be suppressed by right ventricular stimulation after inserting a pacemaker lead. After a period of 12 h a normal QT interval was restored (Figure 3). Unfortunately the patient died 3 days later due to irreversible cerebral damage. The concept of suppressing proarrhythmic effects of quinidine by calcium antagonists is discussed. Despite theoretical advantages of a combination therapy this case report shows that life threatening dysrhythmias cannot be prevented by additional calcium antagonism.