Matsuo C, Yamamoto K, Fukushima H, Yajima D, Inoue H. Recurrent ventricular arrhythmia due to aconite intoxication successfully treated with landiolol: A case report. World J Clin Cases 2023; 11(22): 5303-5308 [PMID: 37621582 DOI: 10.12998/wjcc.v11.i22.5303]
Corresponding Author of This Article
Koji Yamamoto, MD, Doctor, Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City 634-8522, Nara, Japan. k.yamamoto@naramed-u.ac.jp
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 6, 2023; 11(22): 5303-5308 Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5303
Recurrent ventricular arrhythmia due to aconite intoxication successfully treated with landiolol: A case report
Chiaki Matsuo, Koji Yamamoto, Hidetada Fukushima, Daisuke Yajima, Hiroyuki Inoue
Chiaki Matsuo, Koji Yamamoto, Hidetada Fukushima, Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City 634-8522, Nara, Japan
Daisuke Yajima, Hiroyuki Inoue, Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, Narita City 286-8686, Chiba, Japan
Author contributions: Matsuo C wrote the manuscript and prepared the figures; Yamamoto K and Fukushima H conceptualized and designed the study and critically revised the manuscript; Yajima D and Inoue H contributed to the analysis of the patient’s serum samples; all authors read and approved the final manuscript.
Informed consent statement: Informed consent was obtained from the patient to publish the report and associated images.
Conflict-of-interest statement: All the authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Koji Yamamoto, MD, Doctor, Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City 634-8522, Nara, Japan. k.yamamoto@naramed-u.ac.jp
Received: May 18, 2023 Peer-review started: May 18, 2023 First decision: June 21, 2023 Revised: July 1, 2023 Accepted: July 17, 2023 Article in press: July 17, 2023 Published online: August 6, 2023
Abstract
BACKGROUND
Ventricular arrhythmias, such as ventricular tachycardia and fibrillation, are the main causes of death in patients with aconite poisoning.
CASE SUMMARY
A 51-year-old man presented to our emergency department because he was vomiting after ingesting aconite root to attempt suicide. On arrival, the patient was hemodynamically unstable, and his electrocardiogram revealed polymorphic ventricular extrasystoles and non-sustained ventricular tachycardia. Amiodarone was immediately administered for ventricular arrhythmia. However, the patient remained unresponsive. We administered continuous intravenous landiolol as the ventricular arrhythmia worsened, gradually suppressing it. The patient returned to sinus rhythm 16 h after arriving at the hospital. Some aconitum alkaloids act on voltage-gated Na+- channels and induce ventricular or supraventricular tachyarrhythmias. Landiolol suppresses sympathetic nerve activity through its blocking effect, preventing arrhythmia.
CONCLUSION
Landiolol can be a therapeutic option for amiodarone-refractory ventricular arrhythmias caused by aconite intoxication.
Core Tip: Aconite is a well-known plant that contains highly toxic aconitines. Ventricular arrhythmias such as ventricular tachycardia and fibrillation are the main causes of death in patients with aconite poisoning. We encountered a case of polymorphic ventricular arrhythmia that occurred after aconite ingestion. This is the first case where landiolol successfully suppressed ventricular arrhythmia caused by aconite intoxication. Our study suggests that landiolol may be an alternative treatment for amiodarone-refractory ventricular arrhythmias caused by aconite intoxication and can improve the clinical outcomes of patients with aconite intoxication.
