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Report of Two Cases

Jeffrey L. Anderson, MD, FACC; Kishor D. Popat, MD, MRCP(UK); Bertram Pitt, MD, FACC

Arch Intern Med. 1981;141(6):801-802.

Abstract
• Two patients were treated with bretylium tosylate for malignant ventricular arrhythmias after inadequate response to conventional agents. In the first patient, two episodes of ventricular tachycardia requiring cardioversion occurred in close temporal sequence with administering bretylium. With drug rechallenge two days later, ventricular tachycardia recurred within minutes. In the second case, five cardiac arrests due to ventricular tachycardia and fibrillation occurred during several hours after beginning a trial of bretylium maintenance therapy for complex ventricular ectopy. Although transient increases in ectopy after bretylium therapy have been described, presumably due to catecholamine release, the occurrence of life-threatening ventricular arrhythmia leading to cardiac arrest has not previously been emphasized. There is potential for this side effect, and additional caution in the use of this drug should be followed.

(Arch Intern Med 1981;141:801-802)

Author Affiliations
From the Department of Internal Medicine (Drs Anderson, Popat, and Pitt), University of Michigan, and the Upjohn Center for Clinical Pharmacology (Dr Anderson), Ann Arbor. Dr Anderson is now with the University of Utah Medical Center, Salt Lake City.

Footnotes
Accepted for publication April 28, 1980.

Reprint requests to University of Utah Medical Center, Division of Cardiology, LDS Hospital, Salt Lake City, UT 84143 (Dr Anderson).

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