Oral Albuterol for the Treatment of Rate-Dependent QT Prolongation and Polymorphic Ventricular Tachycardia.

OBJECTIVE: We describe a case of rate-related QTc prolongation and related polymorphic ventricular tachycardia (VT) managed using oral albuterol to increase the heart rate, decrease the QTc, and control the VT instead of the conventional management with an automated implantable cardioverter-defibrillator. KEY STEPS: 1) Establish that the patient had QTc prolongation. 2) Verify that polymorphic VT was related to prolonged QTc, which was in turn related to heart rate by titrating dopamine in the intensive care unit and monitoring with telemetry. 3) Titrate albuterol to increase heart rate and then discontinue dopamine. 4) Monitor the patient for stability on oral albuterol. POTENTIAL PITFALLS: The patient became mildly hypotensive due to albuterol; this was managed with midodrine. The patient may experience other arrhythmias due to albuterol. TAKE-HOME MESSAGE: Albuterol is an oral B1 agonist that may be repurposed for increasing heart rate in rate-related polymorphic VT, as in this case, and perhaps in cases of symptomatic sinus bradycardia.