J Korean Soc Emerg Med.  2014 Aug;25(4):471-475. 10.0000/jksem.2014.25.4.471.

Intractable Ventricular Arrhythmia Induced by Aconite and its Successful Treatment with Extracorporeal Membrane Oxygenation Support

• Kim YJ
• Kim OG
• Jang JG
• Rhee I
• Kim WY

• KMID: 2333904
• DOI: http://doi.org/10.0000/jksem.2014.25.4.471

Abstract

Aconite, derived from the roots of certain aconitum species (Racunculaceae), is widely distributed in Korea. Aconitine, an extremely toxic substance present in aconite, has pharmacological effects, including anti-inflammatory, analgesic, and positive inotropic actions. Due to its relatively low safe dose, we sometimes encounter cases of serious aconite intoxication. The toxic compound mainly affects the CNS, heart, and muscle tissues, resulting primarily in cardiovascular complications. Aconite poisoning presents with a combination of neurological, cardiovascular, and gastrointestinal features. The main cause of death is severe cardiotoxicity causing refractory ventricular tachyarrhythmias and asystole. As there is no specific antidote, management of aconite poisoning is supportive. All patients require close monitoring of blood pressure and cardiac rhythm since ventricular arrhythmias may occur during the first 24 hours of poisoning, resulting in sudden deterioration in the patient's clinical condition. Extracorporeal membrane oxygenation (ECMO) has traditionally been utilized for perioperative cardiac failure and cardiomyopathies. More recently, the indications for ECMO have expanded to patients with acute cardiovascular decompression including intractable arrhythmias. We report on a patient who developed life threatening ventricular tachyarrhythmia after ingestion of herbal tablets containing aconite alkaloids. Our patient was resuscitated with intravenous infusion of amiodarone, repeated cardioversion/defibrillation, and mechanical circulatory support with ECMO.

Keyword

Aconitum; Intoxication; Ventricular tachycardia; Extracorporeal membrane oxygenation

MeSH Terms

Aconitine
Aconitum*
Alkaloids
Amiodarone
Arrhythmias, Cardiac*
Blood Pressure
Cardiomyopathies
Cause of Death
Decompression
Eating
Extracorporeal Membrane Oxygenation*
Heart
Heart Arrest
Heart Failure
Humans
Infusions, Intravenous
Korea
Poisoning
Tablets
Tachycardia
Tachycardia, Ventricular
Aconitine
Alkaloids
Amiodarone
Tablets