Theophylline as an adjunct to control malignant ventricular arrhythmia associated with early repolarization

Tilman Perrin (1) , Régis Guieu (2) , Linda Koutbi (1) , Frédéric Franceschi (2, 1) , Jérôme Hourdain (1) , Michele Brignole (3) , Jean-Claude Deharo (2, 1)

1 Département de Cardiologie [Hôpital de la Timone - APHM]
2 DS-ACI / UMR MD2 - Dysoxie, suractivité : aspects cellulaires et intégratifs thérapeutiques
3 Department of Cardiology [Lavagna, Italy]

Early repolarization (ER) has been associated with an increased risk of sudden cardiac arrest. Interestingly, ventricular arrhythmias seem to be triggered by parasympathetic stimulation. In the present case report, we describe complete control of highly frequent malignant ventricular arrhythmias after adding theophylline to ineffective oral hydroquinidine and high-rate pacing in a patient suffering from malignant ER. We hypothesize that the theophylline-mediated enhanced beta-adrenergic stimulation could reduce the transmural myocardial voltage discrepancy by increasing the inward ICa,L current.

Mots clés: theophylline; ventricular arrhythmia; hydroquinidine; early repolarization; adenosine

Domaines: Cardiologie et système cardiovasculaire; Pharmacologie

Tilman Perrin, Régis Guieu, Linda Koutbi, Frédéric Franceschi, Jérôme Hourdain, et al.. Theophylline as an adjunct to control malignant ventricular arrhythmia associated with early repolarization. PACE - Pacing and Clinical Electrophysiology, 2017, 41 (5), pp.444-446. ⟨10.1111/pace.13240⟩. ⟨hal-01760765⟩