Implantable Cardioverter Defibrillator Placement to Permit Ongoing Methadone Treatment Despite QT Prolongation and Torsades de Pointes: A Case Report.
Lauren C Yang, Isaac R Whitman, Jessica Moore
✦ AI-curated · Sources linked
Case in brief
A patient with opioid use disorder receiving methadone developed syncope associated with recurrent polymorphic ventricular tachycardia and QT prolongation. Methadone was considered important because of its effectiveness and the patient’s prior lack of response to alternatives, including buprenorphine. Rather than reduce the methadone dose, clinicians placed an extravascular implantable cardioverter defibrillator to help prevent out-of-hospital cardiac arrest, allowing methadone treatment to continue.
What made this case unusual
The management dilemma was addressed with an extravascular ICD to permit ongoing methadone treatment despite recurrent ventricular arrhythmias, rather than reducing methadone.
Diagnostic / clinical pearl
In a patient with methadone-associated QT prolongation and recurrent arrhythmias, weigh arrhythmic risk against the effectiveness of opioid use disorder treatment and the response to alternatives.
Why it matters
The report supports considering ICD placement in select high-risk patients when continued methadone is important and arrhythmia risk is substantial.