Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5303
Peer-review started: May 18, 2023
First decision: June 21, 2023
Revised: July 1, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: August 6, 2023
Processing time: 77 Days and 0 Hours
Ventricular arrhythmias, such as ventricular tachycardia and fibrillation, are the main causes of death in patients with aconite poisoning.
A 51-year-old man presented to our emergency department because he was vomiting after ingesting aconite root to attempt suicide. On arrival, the patient was hemodynamically unstable, and his electrocardiogram revealed polymorphic ventricular extrasystoles and non-sustained ventricular tachycardia. Amiodarone was immediately administered for ventricular arrhythmia. However, the patient remained unresponsive. We administered continuous intravenous landiolol as the ventricular arrhythmia worsened, gradually suppressing it. The patient returned to sinus rhythm 16 h after arriving at the hospital. Some aconitum alkaloids act on voltage-gated Na+- channels and induce ventricular or supraventricular tachyarrhythmias. Landiolol suppresses sympathetic nerve activity through its blocking effect, preventing arrhythmia.
Landiolol can be a therapeutic option for amiodarone-refractory ventricular arrhythmias caused by aconite intoxication.
Core Tip: Aconite is a well-known plant that contains highly toxic aconitines. Ventricular arrhythmias such as ventricular tachycardia and fibrillation are the main causes of death in patients with aconite poisoning. We encountered a case of polymorphic ventricular arrhythmia that occurred after aconite ingestion. This is the first case where landiolol successfully suppressed ventricular arrhythmia caused by aconite intoxication. Our study suggests that landiolol may be an alternative treatment for amiodarone-refractory ventricular arrhythmias caused by aconite intoxication and can improve the clinical outcomes of patients with aconite intoxication.