Amiodarone/ibrutinib interaction
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Ventricular tachycardia storm and atrial fibrillation : case report A 68-year old man experienced ventricular tachycardia storm following concomitant administration of ibrutinib for Waldenstrom macroglobulinemia and amiodarone. He also developed atrial fibrillation while receiving ibrutinib [ dosages and duration of treatment to reaction onset stated]. The man, who had a history of the acute coronary syndrome and Waldenstrom macroglobulinemia, had been receiving treatment with oral ibrutinib for 2 years. He presented with the complaints of syncope. On the day of presentation, he experienced an episode of dizziness followed by a sudden loss of consciousness which regained spontaneously while watching television. Two minutes later, he spontaneously regained consciousness. He was brought to the emergency department and found to be in atrial fibrillation. During transit to the hospital, he experienced 4 episode of polymorphic ventricular tachycardia, which required multiple defibrillations. His physical examination revealed normal S1 and S2 with no murmurs, equal peripheral pulses with warm and wellperfused extremities. He started receiving amiodarone for recurrent episodes of ventricular tachycardia and was admitted to the cardiac intensive care unit. An ECG showed multiple premature ventricular complexes and non-sustained ventricular tachycardia with a left bundle branch block morphology and right superior axis, indicating an origin at the right ventricular apex. A cardiac magnetic resonance imaging showed a small area of mid-myocardial delayed enhancement in a nonvascular distribution in the basal inferolateral and anterolateral free wall of the left ventricle. The man had been receiving IV amiodarone for recurrent ventricular tachycardia. After the consultation with cardiology, electrophysiology and oncology teams, ibrutinib was discontinued because of the potential association with ventricular tachycardia. He was treated with metoprolol and an implantable cardioverter-defibrillator. During the follow up in every 3 months, there were no further arrhythmias found after placing him on implantable cardioverter-defibrillator. Madgula AS, et al. Ventricular Tachycardia Storm in a Patient Treated With Ibrutinib for Waldenstrom Macroglobulinemia. JACC: CardioOncology 2: 523-526, No. 3, Sep 803516949 2020. Available from: URL: http://doi.org/10.1016/j.jaccao.2020.06.006
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Reactions 21 Nov 2020 No. 1831
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