Ventricular Standstill Following Intravenous Erythromycin and Borderline Hypokalemia

• Main Authors: Saad A Khan, John Ramzy, Danae A Papachristos, Nayana George, Leon Fisher
• Format: Article
• Language: English
• Published: SMC MEDIA SRL 2016-04-01
• Series: European Journal of Case Reports in Internal Medicine
• Subjects: arrhythmias; ventricular standstill; erythromycin
• Online Access: http://ejcrim.com/index.php/EJCRIM/article/view/375

Ventricular standstill (VS) is a potentially fatal arrhythmia that is usually associated with syncope, if prolonged and is rarely asymptomatic[1]. Its mechanism involves either a lack of supraventricular impulse or an interruption in the transmission of these signals from the atria to the ventricles, resulting in a sudden loss of cardiac output[2]. Although rare, ventricular arrhythmias have been associated with intravenous (IV) erythromycin. However, to our knowledge, VS has not been reported following the administration of IV erythromycin. The Authors  describe a rare case of asymptomatic VS and subsequent third-degree atrioventricular block, following the administration of IV erythromycin in a 49-year-old woman with borderline hypokalemia. Through this case, the Authors highlight the importance of cardiac monitoring and electrolyte replacement when administering IV erythromycin, as well as discuss several other mechanisms that contribute to ventricular arrhythmias.