Frequent ventricular extrasystoles after heart transplantation: a late presentation of amiodarone-induced thyrotoxicosis: a case report.

Amiodarone Case report Heart failure Heart transplantation Thyrotoxicosis Ventricular extrasystoles

Journal

European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741

Informations de publication

Date de publication:
01 Jun 2019
Historique:
received: 29 03 2018
accepted: 01 03 2019
entrez: 27 8 2019
pubmed: 27 8 2019
medline: 27 8 2019
Statut: ppublish

Résumé

There is a lack of information about a mixed type of amiodarone-induced thyrotoxicosis (AIT) after heart transplantation (HTx) with no amiodarone treatment in almost 1 year. Frequent ventricular extrasystoles (VES) associated with a mixed type of AIT can often be treated using thiamazole and prednisolone, without the need for specific antiarrhythmic treatment. We present a clinical case of a 65-year-old heart transplanted male patient with frequent VES associated with mixed type of AIT. Recipient had managed with amiodarone prior to HTx but there were no indications for it after the surgery. One year after antiarrhythmic treatment was discontinued, monomorphic VES (total amount: 27 472/day) were diagnosed. In addition, our investigation revealed that thyrotoxicosis developed. Prednisolone and thiamazole were added to the treatment with positive outcomes. The antithyroid treatment had been discontinued after 9 months and results of the 24-h Holter electrocardiogram monitoring showed only two VES/24 h. The case highlights the association of amiodarone, thyroid disorders, and VES. In mixed type AIT or if diagnosis is uncertain, it is reasonable to use mixed therapy. Next is to decide whether you need special treatment for VES. There was no evidence of ventricular tachycardia. Thyroid function tests remained normal off antithyroid medications and the total amount of VES significantly decreased. There were no indications for any antiarrhythmic treatment or ablation.

Sections du résumé

BACKGROUND BACKGROUND
There is a lack of information about a mixed type of amiodarone-induced thyrotoxicosis (AIT) after heart transplantation (HTx) with no amiodarone treatment in almost 1 year. Frequent ventricular extrasystoles (VES) associated with a mixed type of AIT can often be treated using thiamazole and prednisolone, without the need for specific antiarrhythmic treatment.
CASE SUMMARY METHODS
We present a clinical case of a 65-year-old heart transplanted male patient with frequent VES associated with mixed type of AIT. Recipient had managed with amiodarone prior to HTx but there were no indications for it after the surgery. One year after antiarrhythmic treatment was discontinued, monomorphic VES (total amount: 27 472/day) were diagnosed. In addition, our investigation revealed that thyrotoxicosis developed. Prednisolone and thiamazole were added to the treatment with positive outcomes. The antithyroid treatment had been discontinued after 9 months and results of the 24-h Holter electrocardiogram monitoring showed only two VES/24 h.
DISCUSSION CONCLUSIONS
The case highlights the association of amiodarone, thyroid disorders, and VES. In mixed type AIT or if diagnosis is uncertain, it is reasonable to use mixed therapy. Next is to decide whether you need special treatment for VES. There was no evidence of ventricular tachycardia. Thyroid function tests remained normal off antithyroid medications and the total amount of VES significantly decreased. There were no indications for any antiarrhythmic treatment or ablation.

Identifiants

DOI: 10.1093/ehjcr/ytz030 PMID: 31449587 PMC: PMC6601152
pubmed: 31449587
pii: 5416178
doi: 10.1093/ehjcr/ytz030
pmc: PMC6601152
pii:
doi:

Types de publication

Journal Article

Langues

eng

Informations de copyright

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.

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Auteurs

Maria Simonenko (M)

Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Federal State Budgetary Institution, "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation, 197341, Akkuratova street, 2, Saint-Petersburg, Russian Federation.

Petr Fedotov (P)

Heart Failure Research Department, Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation, 197341, Akkuratova street, 2, Saint-Petersburg, Russian Federation.

Alina Babenko (A)

Endocrynology Institute, Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation, 197341, Akkuratova street, 2, Saint-Petersburg, Russian Federation.

Mikhail Karpenko (M)

Scientific Clinical Council, Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation, 197341, Akkuratova street, 2, Saint-Petersburg, Russian Federation.

Classifications MeSH