CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 4, July/August 2010
AFRICA
225
Serotonin and catecholaminergic polymorphic ventricular
tachycardia: a possible therapeutic role for SSRIs?
S CHEN, Q DUAN, K TANG, D ZHAO, Y XU
Summary
Catecholaminergic polymorphic ventricular tachycardia
(CPVT) is a rare malignant arrhythmia, usually diagnosed in
the adolescent years. The diagnosis can typically be made by
one or more of the following: a positive family history, exer-
cise electrocardiography, ambulatory ECG monitoring and/
or an intra-cardiac, electrophysiological examination. This is
a case report of a patient with CPVT that was refractory to
treatment with beta-blockade and an implanted automatic
cardioverter defibrillator. However, after a selective serotonin
re-uptake inhibitor (SSRI) was added to the therapeutic regi-
men, no further episodes of ventricular tachycardia occurred
during the following two years.
Keywords:
catecholamine, polymorphic, ventricular tachycar-
dia, gene mutation, selective serotonin reuptake inhibitor
Submitted 7/11/09, accepted 10/3/10
Cardiovasc J Afr
2010;
21
: 225–228
DOI: CVJ-21.005
Catecholaminergic polymorphic ventricular tachycardia (CPVT)
is one of the malignant ventricular arrhythmias, which was first
reported by Leenhardt in 1995. CPVT is a familial disease with
genetic mutations detectable in approximately 50% of patients.
These include the RyR2 (ryanodine receptor) and CASQ2
(calsequestrin) mutations.
1
CPVT often presents during child-
hood and the adolescent years, with the main clinical manifesta-
tion of sudden syncope during exercise or episodes of emotional
distress. During such episodes there are often no known trig-
gers present, such as electrolyte disturbances. It is important to
exclude one of the primary ion channel diseases, such as long-
QT syndrome (LQTS) and Brugada syndrome.
Case report
A 23-year-old woman presented to our clinic with the clinical
problem of repeated syncope events over the past 15 years. These
attacks were more frequent during episodes of emotional distress.
During 2004, 24-hour ambulatory ECG monitoring was done
by the referring hospital. It revealed frequent episodes of multi-
focal ventricular premature contractions. Because of this, meto-
prolol (12.5 mg twice daily) was prescribed. The patient was also
sent for a psychological evaluation, and anxiety disorder with
panic attacks was diagnosed and, subsequently, paroxetine (20
mg daily) was also prescribed.
Department of Cardiology, 10th People’s Hospital of Tongji
University, Shanghai, China
SHUNJUAN CHEN, MD
KAI TANG, MD
DONGDONG ZHAO, MD
YAWEI XU, MD,
Department of Scientific Research, Tongji Hospital of Tongji
University, Shanghai, China
QIANGLIN DUAN, MD
Fig. 1. 12-lead ECG of patient’s ventricular tachycardia.
