TY - JOUR
T1 - A case of life-threatening supraventricular tachycardia storm associated with theophylline toxicity
AU - Ichikawa, Keishi
AU - Wada, Tadashi
AU - Nishihara, Takahiro
AU - Tsuji, Masahiro
AU - Mori, Atsushi
AU - Yokohama, Fumi
AU - Hasegawa, Daiji
AU - Kawamoto, Kenji
AU - Tanakaya, Machiko
AU - Katyama, Yusuke
AU - Sakuragi, Satoru
AU - Ito, Hiroshi
N1 - Publisher Copyright:
© 2017 Japanese College of Cardiology
PY - 2017/4/1
Y1 - 2017/4/1
N2 - A 76-year-old man taking theophylline was admitted to our hospital with congestive heart failure and supraventricular tachycardia (SVT). After admission, he developed cardiogenic shock as a result of SVT storm, which was refractory to medical treatment including adenosine and electrical cardioversion. The serum theophylline concentration at admission was identified as toxic. Therefore, theophylline toxicity was considered as a major cause of the SVT storm. Hemodynamic stability was achieved by using mechanical circulatory support. Additionally, continuous hemodiafiltration was performed to remove theophylline, and it was effective for suppression of SVT. The patient was successfully weaned off mechanical circulatory support. After the patient's general status had improved, an electrophysiological study was performed, and it showed orthodromic atrioventricular reentrant tachycardia with a right free wall accessory pathway. Radiofrequency catheter ablation was successfully performed. <Learning objective: SVT is often hemodynamically stable and medically well-controllable with adenosine. However, SVT is occasionally refractory or life-threatening under specific conditions such as theophylline toxicity, since theophylline has an inhibitor effect on adenosine. Mechanical circulatory support should be used in case of life-threatening SVT storm associated with theophylline toxicity.>
AB - A 76-year-old man taking theophylline was admitted to our hospital with congestive heart failure and supraventricular tachycardia (SVT). After admission, he developed cardiogenic shock as a result of SVT storm, which was refractory to medical treatment including adenosine and electrical cardioversion. The serum theophylline concentration at admission was identified as toxic. Therefore, theophylline toxicity was considered as a major cause of the SVT storm. Hemodynamic stability was achieved by using mechanical circulatory support. Additionally, continuous hemodiafiltration was performed to remove theophylline, and it was effective for suppression of SVT. The patient was successfully weaned off mechanical circulatory support. After the patient's general status had improved, an electrophysiological study was performed, and it showed orthodromic atrioventricular reentrant tachycardia with a right free wall accessory pathway. Radiofrequency catheter ablation was successfully performed. <Learning objective: SVT is often hemodynamically stable and medically well-controllable with adenosine. However, SVT is occasionally refractory or life-threatening under specific conditions such as theophylline toxicity, since theophylline has an inhibitor effect on adenosine. Mechanical circulatory support should be used in case of life-threatening SVT storm associated with theophylline toxicity.>
KW - Mechanical circulatory support
KW - Supraventricular tachycardia storm
KW - Theophylline toxicity
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U2 - 10.1016/j.jccase.2016.12.004
DO - 10.1016/j.jccase.2016.12.004
M3 - Article
AN - SCOPUS:85014484272
SN - 1878-5409
VL - 15
SP - 125
EP - 128
JO - Journal of Cardiology Cases
JF - Journal of Cardiology Cases
IS - 4
ER -