Sildenafil Induced Ventricular Tachycardia In A Healthy Man
A 65 year-old previously healthy man
with no cardiovascular risk factors such as smoking, hypertension,
hyperlipidemia and diabetes, had admitted to our emergency department by
paramedics via ambulance. There was no history of cardiopulmonary symptoms and
no family history of heart disease or sudden death. Patient felt dizzy, had
palpitation and chest pain. Electrocardiography showed ventricular tachycardia
with a frequency of 234 bpm (Figure 1). Blood pressure was 105/60 mmHg. Patient
stated that he has taken 200 mg Sildenafil before admission to the hospital and
he was not taking any other drugs. He told that he used Sildenafil for the
first time. After electrical cardioversion and converted to sinus rhythm, he
immediately underwent coronary angiography and we saw only antherosclerotic
plaques on left anterior descending coronary artery and right coronary artery.
Blood tests were within normal range. His chest x-ray and echocardiography was
unremarkable. We implanted prophylactic implantable cardioverter defibrillator (ICD)
to the patient and suggested not to use Sildenafile citrate.
Sildenafil
is the one of the most commonly used drugs over the world for erectyle
dysfunction treatment. In the past few years, a growing number of studies have
reported that this lethal arrhythmia led to sudden cardiac death in many
middleaged men treated with sildenafil citrate 1,2,3,4. Sildenafil
citrate induces a dosedependent block of the rapid component of the delayed
rectifier potassium current is according to Geelen and colleagues. Same study
reported that class III antiarrhythmic drugs and sildenafil citrate have
similar actions 5 . Swissa and colleueges showed that mixed usage of
nitric oxide and sildenafil citrate causes rised ventricular tachycardia /
fibrillation vulnerability in righ ventricle of pig heart 6 .
Despite the evidences which shows the arrhythmogenic effects of sildenafil
citrate, some studies showed contradictory results. Kaya and colleueges
reported that Sildenafil does not effect QT dynamic properties 7.
Vardi and colleagues found that Sildenafil does not increase rate of
ventricular arrhythmias in man who has erectile dysfunction and cardiovascular
disease 8 . Also Nagy and colleagues showed that sildenafil reduces
arrhythmia severity during ischemia in dogs 9. Our patient was admitted to our clinic with
ventricular tachycardia even though he had no cardiac risk and he has taken
Sildenafil for the first time in his life. In our opinion Sildenafil usage
increased ventricular arrhythmia vulnerability and caused ventricular
tachycardia.
Sildenafil Induced Ventricular Tachycardia In A Healthy Man
A 65 year-old previously healthy man
with no cardiovascular risk factors such as smoking, hypertension,
hyperlipidemia and diabetes, had admitted to our emergency department by
paramedics via ambulance. There was no history of cardiopulmonary symptoms and
no family history of heart disease or sudden death. Patient felt dizzy, had
palpitation and chest pain. Electrocardiography showed ventricular tachycardia
with a frequency of 234 bpm (Figure 1). Blood pressure was 105/60 mmHg. Patient
stated that he has taken 200 mg Sildenafil before admission to the hospital and
he was not taking any other drugs. He told that he used Sildenafil for the
first time. After electrical cardioversion and converted to sinus rhythm, he
immediately underwent coronary angiography and we saw only antherosclerotic
plaques on left anterior descending coronary artery and right coronary artery.
Blood tests were within normal range. His chest x-ray and echocardiography was
unremarkable. We implanted prophylactic implantable cardioverter defibrillator (ICD)
to the patient and suggested not to use Sildenafile citrate.
Sildenafil is the one of the most
commonly used drugs over the world for erectyle dysfunction treatment. In the
past few years, a growing number of studies have reported that this lethal arrhythmia
led to sudden cardiac death in many middleaged men treated with sildenafil
citrate 1,2,3,4. Sildenafil citrate induces a dosedependent block of
the rapid component of the delayed rectifier potassium current is according to
Geelen and colleagues. Same study reported that class III antiarrhythmic drugs
and sildenafil citrate have similar actions 5 . Swissa and
colleueges showed that mixed usage of nitric oxide and sildenafil citrate
causes rised ventricular tachycardia / fibrillation vulnerability in righ
ventricle of pig heart 6 . Despite the evidences which shows the
arrhythmogenic effects of sildenafil citrate, some studies showed contradictory
results. Kaya and colleueges reported that Sildenafil does not effect QT
dynamic properties 7. Vardi and colleagues found that Sildenafil
does not increase rate of ventricular arrhythmias in man who has erectile
dysfunction and cardiovascular disease 8 . Also Nagy and colleagues
showed that sildenafil reduces arrhythmia severity during ischemia in dogs 9.
Our patient was admitted to our clinic
with ventricular tachycardia even though he had no cardiac risk and he has
taken Sildenafil for the first time in his life. In our opinion Sildenafil
usage increased ventricular arrhythmia vulnerability and caused ventricular
tachycardia.
___
- 1- Kloner RA (2000). Cardiovascular risk and sildenafil. American Journal of Cardiology, 86: 57F-61F.
- 2- Kobayashi M, Takata Y, Goseki Y, et al. A sudden cardiac death induced by sildenafil and sexual activity in an HIV patient with drug interaction, cardiac early repolarization, and arrhythmogenic right ventricular cardiomyopathy. Int J Cardiol. 2015 Jan 20;179:421-3. doi: 10.1016/j.ijcard.2014.11.090. Epub 2014 Nov 11.
- 3- Falcón-Chévere JL1, Cabañas JG, Canales-Colón I, Martorell-Millan G. Boletín de la Asociación Médica de Puerto Rico 2007 Oct-Dec;99(4):325-30.
- 4- Rasmussen JG, Toft E, Frøbert O. Ventricular tachycardia after administration of sildenafil citrate: a case report. Journal of Medical Case Reports J Med Case Rep. 2007 Aug 13;1:65.
- 5- Geelen P, Drolet B, Rail J,et al. Sildenafil (Viagra) prolongs cardiac repolarization by blocking the rapid component of the delayed rectifier potassium current. Circulation, 102: 275-277.
- 6- Swissa M, Ohara T, Lee MH,et al. Sildenafil-nitric oxide donor combination promotes ventricular tachyarrhythmias in the swine right ventricle. American Journal of Physiology, 282: H1787-H1792.
- 7- Kaya D, Guler C, Esen AM, et al. Sildenafil citrate does not alter ventricular repolarization properties: novel evidence from dynamic QT analysis. Annals of Noninvasive Electrocardiology, 9: 228-233.
- 8- Vardi Y, Bulus M, Reisner S, et al. Effects of sildenafil citrate (Viagra) on hemodynamic parameters during exercise testing and occurrence of ventricular arrhythmias in patients with erectile dysfunction and cardiovascular disease. European Urology, 43: 544-551.
- 9- Nagy O, Hajnal A, Parratt JR & Vegh A . Sildenafil (Viagra) reduces arrhythmia severity during ischaemia 24 h after oral administration in dogs. British Journal of Pharmacology, 141: 549-551.
