Aconitine poisoning presenting as atrial fibrillation with slow ventricular rate: A case report

Abstract

Aconitine is a diterpenoid diester alkaloid primarily found in traditional Chinese herbs. It is rapidly absorbed through the upper gastrointestinal tract and exhibits some beneficial effects. However, due to its toxicity, improper use of aconitine can easily lead to poisoning, primarily characterized by cardiovascular and neurological toxicity. Most cases of aconitine poisoning involve multiple types of arrhythmias, with rapid ventricular arrhythmias being the most common. However, it can also result in bradyarrhythmias. We report a case of aconitine poisoning manifesting as atrial fibrillation with slow ventricular rate and an ST-segment resembling a fishhook pattern on the electrocardiogram, detailing its clinical presentation and treatment approach. This case report highlights the importance of healthcare professionals thoroughly reviewing patients' medical history and medication use to identify and address adverse drug reactions.

Learning objectives

• 1.
  Recognize that aconitine poisoning, while commonly presenting with rapid ventricular arrhythmias, can also manifest as bradyarrhythmias, including atrial fibrillation with slow ventricular response.
• 2.
  Identify the potential electrocardiographic finding of a fishhook-shaped ST-segment as a clue in suspected aconitine toxicity.
• 3.
  Emphasize the critical importance of a thorough review of a patient's medication history and use of traditional herbs in the evaluation of unexplained arrhythmias.