caa a22 4500 445824840 CHVBK 20180317145256.0 cr unu---uuuuu 170323e20110401xx s 000 0 eng 10.1007/s00246-011-9914-y doi (NATIONALLICENCE)springer-10.1007/s00246-011-9914-y Temporary Cardiac Pacemaker in the Treatment of Junctional Rhythm and Hypotension Due to Imipramine Intoxication [Elektronische Daten] [Ahmet Sert, Ebru Aypar, Dursun Odabas, M. Aygul] Tricyclic antidepressants (TCAs) account for approximately 3% of all pediatric hospitalizations due to poisoning. TCAs remain a common cause of fatal drug poisoning because of their cardiovascular toxicity as manifested by electrocardiogram (ECG) abnormalities, arrhythmias, and hypotension. We report a 15-year-old girl with junctional escape rhythm and resistant hypotension caused by severe imipramine intoxication. Initial ECG showed junctional escape rhythm (46bpm) with no atrial activity, low QRS voltage, widening of the QRS complex (160ms) with a right bundle branch-like pattern, R wave>3mm in aVR (6mm), and prolongation of the QT interval (QTc 550ms). Despite intravenous fluids and inotropic support, she had resistant hypotension and acute renal failure. Junctional rhythm was successfully terminated by using temporary cardiac pacemaker. Hemodialysis and hemoperfusion were also performed. She was discharged on the day 5 without any complications. During follow-up, no ECG abnormalities were noted. We reported successful use of temporary cardiac pacemaker for treatment of junctional rhythm and resistant hypotension in imipramine intoxication. The conventional methods of activated charcoal, alkalinization, and symptomatic treatment of complications are usually enough for nonlethal doses of TCA intoxication. However, in imipramine intoxication with serious arrythmias and hypotension, using temporary cardiac pacemaker, hemodialysis, and hemoperfusion can be a life-saving therapeutic approach. Springer Science+Business Media, LLC, 2011 Children nationallicence Imipramine poisoning nationallicence Junctional rhythm nationallicence Temporary pacemaker nationallicence Sert Ahmet Department of Pediatric Cardiology, Konya Training and Research Hospital, 42080, Konya, Turkey aut Aypar Ebru Department of Pediatric Cardiology, Konya Training and Research Hospital, 42080, Konya, Turkey aut Odabas Dursun Department of Pediatric Cardiology, Konya Training and Research Hospital, 42080, Konya, Turkey aut Aygul M. Department of Cardiology, Konya Training and Research Hospital, 42080, Konya, Turkey aut Pediatric Cardiology Springer-Verlag 32/4(2011-04-01), 521-524 0172-0643 32:4<521 2011 32 246 https://doi.org/10.1007/s00246-011-9914-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00246-011-9914-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Sert Ahmet Department of Pediatric Cardiology, Konya Training and Research Hospital, 42080, Konya, Turkey aut NATIONALLICENCE 700 1- Aypar Ebru Department of Pediatric Cardiology, Konya Training and Research Hospital, 42080, Konya, Turkey aut NATIONALLICENCE 700 1- Odabas Dursun Department of Pediatric Cardiology, Konya Training and Research Hospital, 42080, Konya, Turkey aut NATIONALLICENCE 700 1- Aygul M. Department of Cardiology, Konya Training and Research Hospital, 42080, Konya, Turkey aut NATIONALLICENCE 773 0- Pediatric Cardiology Springer-Verlag 32/4(2011-04-01), 521-524 0172-0643 32:4<521 2011 32 246 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer