Recurrent Torsades de Pointes Precipitated by Berberine Supplement
Abstract
BACKGROUND: Acquired long QT syndrome and torsades de pointes (TdP) can be triggered by dietary supplements, which do not go through strict safety testing.
CASE SUMMARY: A 61-year-old man had syncope and recurrent TdP (QTc 669 ms), with an initial electrocardiogram phenotype indistinguishable from congenital LQT2. He was taking several over-the-counter supplements including berberine, dihydroberberine, turmeric, and quercetin and had mild hypomagnesemia. Genetic testing for congenital long QT syndrome was negative. Management included defibrillation, intravenous magnesium, supplement discontinuation, nadolol, and a wearable cardioverter-defibrillator. The QT interval normalized, and nadolol was later discontinued without arrhythmia recurrence.
DISCUSSION: This case illustrates a "multihit" model, in which supplement-mediated cardiac channel blockade, drug interactions increasing supplement exposure, and hypomagnesemia converged to provoke life-threatening arrhythmia.
TAKE-HOME MESSAGES: Common supplements like berberine can cause TdP through multiple proarrhythmic mechanisms. Thorough evaluation for extrinsic triggers is essential, even when the electrocardiographic phenotype suggests a genetic disorder.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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