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Fosphenytoin for control of electrical storm in acute myocardial infarction and Purkinje fiber mediated arrhythmias.

Research paper by Maneesh K MK Rai, Narasimha N Pai, Kashyap K Patel, Mukund A MA Prabhu, Jayashanker J Marla, Padmanabh P Kamath, Ramanath L RL Kamath

Indexed on: 15 Apr '18Published on: 15 Apr '18Published in: Pacing and Clinical Electrophysiology



Abstract

Purkinje Fibre mediated Arrhythmias in the setting of Acute Myocardial Infarction are poorly responsive to conventional anti-arrhythmic therapy, increases overall mortality and often requires Radiofrequency ablation (RFA) for control. In this study we report the use of intravenous Fosphenytoin for the control of arrhythmic storm in patients with Acute Myocardial Infarction. 6 patients with Acute Myocardial Infarction (5 AW/1 LW) and Purkinje Triggered ventricular arrhythmias refractory to conventional anti-arrhythmics were treated with intravenous Fosphenytoin (600 mg-1 gm) before considering RFA. Arrhythmia control was obtained in all patients after the initial bolus dose. Breakthrough episodes were seen in 5/6 within 24-36 hrs of the initial bolus, necessitating a second bolus. Complete arrhythmia control was obtained in all patients within 72 hrs and 5/6 patients were successfully discharged from the hospital. One patient succumbed to sepsis in hospital while another patient succumbed to Sub Dural Hematoma after 3 months. Intravenous Fosphenytoin should be considered before RFA for control of Purkinje fibre mediated refractory arrhythmias in Acute Myocardial Infarction patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.