Voriconazole-induced bradycardia without QT interval prolongation: A possible non-concentration-dependent adverse effect

摘要

A 78-year-old man was admitted to the ICU for acute respiratory failure after abdominal surgery. One month later IPA due to Aspergillus fumicatus was diagnosed. Voriconazole therapy was initiated (400 mg twice per day). He also received propofol, remifen-tanil, haloperidol, nefopam, piperacillin-tazobactam and gaba-pentine. Three days later, however, the patient experienced several episodes of spontaneous and extreme bradycardia with complete atrioven-tricular block and a QTc up to 0.36 s on the electrocardiogram (Fig. 1), requiring the administration of iso-prenaline. The serum potassium level was 3.6 mmol/L.