Polymorphic ventricular tachycardia and cardiac arrest from abiraterone-induced hypokalemia: a case report

Jessica Mao; Allison Komatsu Chang; Stephen Chin; Komal Preet; Nare Torosyan; Sarmen Sarkissian; Joseph Ebinger

doi:10.1186/s13256-024-04513-3

Polymorphic ventricular tachycardia and cardiac arrest from abiraterone-induced hypokalemia: a case report

J Med Case Rep. 2024 Apr 16;18(1):186. doi: 10.1186/s13256-024-04513-3.

Authors

Jessica Mao¹, Allison Komatsu Chang², Stephen Chin³, Komal Preet⁴, Nare Torosyan³, Sarmen Sarkissian⁵, Joseph Ebinger⁶

Affiliations

¹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
² Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³ Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁴ David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.
⁵ Department of Hematology-Oncology, Memorial Care, Long Beach, CA, USA.
⁶ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. joseph.ebinger@csmc.edu.

Abstract

Background: Polymorphic ventricular tachycardia (PMVT) is an unstable and often fatal cardiac tachyarrhythmia. While there are many causes of this rhythm, including electrolyte imbalances, ischemia, and genetic disorders, iatrogenic etiologies are important to recognize. Abiraterone is an androgen synthesis antagonist effective in treating prostate cancer, but here we describe a case of severe hypokalemia secondary to abiraterone resulting in polymorphic ventricular tachycardia and cardiac arrest. While this is a potential adverse effect of the medication, severe hypokalemia causing polymorphic ventricular tachycardia and cardiac arrest, as seen in our patient's case, has not been described.

Case presentation: A 78-year-old African-American man with history of prostate cancer presents with polymorphic ventricular tachycardia and cardiac arrest. After resuscitation, he was found to be severely hypokalemic and refractory to large doses of repletion. Evaluation of secondary causes of hypokalemia identified the likely culprit to be adverse effects from prostate cancer treatment.

Conclusion: A broad differential diagnosis for polymorphic ventricular tachycardia is essential in identifying and treating patients presenting in this rhythm. Here we present a case of iatrogenic polymorphic ventricular tachycardia secondary to oncologic treatment.

Keywords: Arrhythmia; Critical care; Electrolyte derangement; Medication side effect.

Publication types

Case Reports

MeSH terms

Aged
Androstenes*
Heart Arrest* / etiology
Humans
Hypokalemia* / chemically induced
Iatrogenic Disease
Male
Prostatic Neoplasms* / complications
Prostatic Neoplasms* / drug therapy
Tachycardia, Ventricular* / diagnosis

Substances

abiraterone
Androstenes