Atropine
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Lack of efficacy: case report A 40-year-old man exhibited lack of efficacy during treatment with atropine for paroxysmal ventricular standstill. The man, who was normally fit and healthy suddenly became floppy in a sitting position. About a minute later, he regained consciousness. However, he had another three similar episodes with the ambulance crew. In the emergency department, he had ten episodes of brief periods of unresponsiveness. Later, he would sit up in bed and try to get off and thereby requiring restraint. He underwent various tests during a lucid period and an impression of pseudo-seizure was made. He had two 12-lead ECG recordings in between the episodes, and both ECG recording revealed sinus rhythm with right bundle branch block. He started receiving phenytoin infusion due to the numerous seizure-like attacks. Subsequently, he had another episode of brief loss of consciousness. During this episode, a rhythm of paroxysmal ventricular standstill was noted on the defibrillator and a 12-lead ECG was obtained towards the tail-end of his seizure-like episode. Hence, immediately he was administered IV atropine 500µg for paroxysmal ventricular standstill; however, no effect was noted and he underwent transcutaneous pacing. His seizure-like episodes were determined to be Stokes-Adams attacks. Subsequently, the man was transferred to a cardiac center for temporary pacing wires and eventually a permanent pacemaker was placed. During follow-up, no further episodes were noted. Adegoke DA. Paroxysmal ventricular standstill: A rare cardiac manifestation of syncope. American Journal of Case Reports 21: 1-5, Jun 2020. Available from: URL: https:// 803497902 www.researchgate.net/publication/342601495_Paroxysmal_Ventricular_Standstill_A_Rare_Cardiac_Manifestation_of_Syncope
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Reactions 22 Aug 2020 No. 1818
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