Pro-arrhythmogenic effect of lappaconitine hydrobromide

The article presents a clinical case of the development of the pro-arrhythmogenic effect of lappaconitine hydrobromide in the form of monomorphic ventricular tachycardia in a 68-year-old female patient. Upon admission, there were complaints of a constant feeling of heaviness in the sternum and shortness of breath, episodes of dizziness and unsteadiness when walking, interruptions in the work of the heart, occurring with minor physical exertion. The patient has a history of type 2 myocardial infarction (two years ago), during inpatient treatment ventricular tachycardia was recorded, due to which amiodarone was prescribed. At the outpatient stage, amiodarone was replaced with lappaconitine hydrobromide. Three days before the current hospitalization, during Holter ECG monitoring, frequent ventricular extrasystoles, episodes of unstable and stable ventricular monomorphic tachycardia were recorded. The detected arrhythmia was assessed as a proarrhythmogenic effect of lappaconitine hydrobromide, due to which this drug was discontinued and amiodarone was prescribed. During echocardiography on the second day of hospitalization, diffuse myocardial hypokinesia was detected, a decrease in the left ventricular ejection fraction to 48%. During the treatment, an improvement in well-being was noted: chest discomfort, shortness of breath, and attacks of palpitations did not bother. One month after hospitalization, outpatient echocardiography showed an increase in the left ventricular ejection fraction to 54%. The presented case draws the attention of practicing physicians to the need to monitor the effectiveness and safety of antiarrhythmic therapy, especially in patients with organic myocardial damage.