Korean Circ J.  2011 Jun;41(6):342-345. 10.4070/kcj.2011.41.6.342.

QT Prolongation and Life Threatening Ventricular Tachycardia in a Patient Injected With Intravenous Meperidine (Demerol(R))

• Song MK
• Bae EJ
• Baek JS
• Kwon BS
• Kim GB
• Noh CI
• Choi JY
• Park SS

• KMID: 1776194
• DOI: http://doi.org/10.4070/kcj.2011.41.6.342

Abstract

QT prolongation is a serious adverse drug effect, which is associated with an increased risk of Torsade de pointes and sudden death. Many drugs, including both cardiac and non-cardiac drugs, have been reported to cause prolongation of QT interval. Although meperidine has not been considered proarrhythmic, we present a unique case of a 16-year-old boy without an underlying cardiac disease, who developed polymorphic ventricular tachycardia, ventricular fibrillation and QT prolongation after an intravenous meperidine injection. He had no mutation in long QT syndrome genes (KCNQ1, KCNH2, and SCN5A), but single nucleotide polymorphisms were reported, including H558R in SCNA5A and K897T in KCNH2.

Keyword

Long QT syndrome; Meperidine; Torsade de pointes

MeSH Terms

Adolescent
Death, Sudden
Heart Diseases
Humans
Long QT Syndrome
Meperidine
Polymorphism, Single Nucleotide
Tachycardia, Ventricular
Torsades de Pointes
Ventricular Fibrillation
Meperidine

Figure

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  Fig. 1 Ventricular fibrillation at the time of cardiac arrest.

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  Fig. 2 Electrocardiogram the day after ventricular fibrillation developed. QTc interval is 591 msec.

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  Fig. 3 Epinephrine test results. Six days after cardiopulmonary resuscitation, baseline electrocardiogram reveals normal QTc interval (A: QTc 431 msec), but 30 seconds after epinephrine bolus injection (0.1 µg/kg), followed by continuous infusion (0.1 µg/kg/min), QTc interval became prolonged up to 587 msec (B). Two years after cardiopulmonary resuscitation, epinephrine test shows normal (C: QTc 418 msec).

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