{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T05:50:25Z","timestamp":1769579425677,"version":"3.49.0"},"reference-count":11,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Noninvasive Electrocardiol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Aconitine poisoning produces lethal ventricular arrhythmias through persistent activation of cardiac sodium channels. We critically comment on a recent case report describing 28 biphasic shocks for aconitine\u2010induced electrical storm, addressing three fundamental questions. First, we demonstrate that verapamil is contraindicated as it worsens hypotension and reflex sympathetic activation without antagonizing sodium channel toxicity. Second, we review the evidence for magnesium sulfate: while basic science and observational data support its mechanistic role as a calcium antagonist and sodium channel modulator, Class IC antiarrhythmics (flecainide) demonstrate superior conversion rates (86% vs. 22% for magnesium monotherapy). Magnesium should be viewed as an evidence\u2010based adjunct, not mandated first\u2010line therapy. Third, we identify critical monitoring gaps including dynamic electrolyte assessment, ionized calcium repletion, and toxin quantification that must be addressed in future cases. We propose a practical, evidence\u2010based algorithm emphasizing: (1) first\u2010line flecainide 2\u2009mg\/kg IV, (2) magnesium sulfate adjunct targeting serum levels of 1.5\u20132.0\u2009mmol\/L, (3) aggressive calcium repletion to &gt;\u20091.00\u2009mmol\/L, (4) early high\u2010flux hemoperfusion within 6\u2009h, and (5) VA\u2010ECMO for refractory cases. Verapamil, diltiazem, and \u03b2\u2010blockers as sole agents should be explicitly avoided.<\/jats:p>","DOI":"10.1111\/anec.70133","type":"journal-article","created":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T06:43:28Z","timestamp":1764398608000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Magnesium in Aconitine\u2010Induced Electrical Storm\u2014Mechanism Yes, Mandate No"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0982-5194","authenticated-orcid":false,"given":"Zhong\u2010Qun","family":"Zhan","sequence":"first","affiliation":[{"name":"Department of Cardiology Shenzhen Guangming District People's Hospital  Shenzhen P. R. China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1626-4867","authenticated-orcid":false,"given":"Hai\u2010Jun","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000902"},{"issue":"5","key":"e_1_2_12_3_1","first-page":"792","article-title":"Electrophysiological Effects of Magnesium on Aconitine\u2010Induced Delayed After\u2010Depolarisations in Guinea\u2010Pig Papillary Muscles","volume":"14","author":"Borchard U.","year":"1989","journal-title":"Journal of Cardiovascular Pharmacology"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650902904407"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2017.1291944"},{"issue":"3","key":"e_1_2_12_6_1","first-page":"291","article-title":"Expert Consensus on Diagnosis and Treatment of Acute Aconitum Alkaloid Poisoning","volume":"32","author":"Emergency Physician Branch of Chinese Medical Doctor Association","year":"2022","journal-title":"Chinese Journal of Emergency Medicine"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0014-2999(97)01268-5"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000532050"},{"issue":"11","key":"e_1_2_12_9_1","first-page":"1155","article-title":"Magnesium Sulfate Increases Ventricular Fibrillation Threshold in Aconitine\u2010Intoxicated Rats","volume":"33","author":"Liu X.","year":"2014","journal-title":"Human & Experimental Toxicology"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000916"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.1998.1238"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/anec.70124"}],"container-title":["Annals of Noninvasive Electrocardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anec.70133","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/anec.70133","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anec.70133","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T17:25:30Z","timestamp":1769534730000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/anec.70133"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/anec.70133"],"URL":"https:\/\/doi.org\/10.1111\/anec.70133","archive":["Portico"],"relation":{},"ISSN":["1082-720X","1542-474X"],"issn-type":[{"value":"1082-720X","type":"print"},{"value":"1542-474X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]},"assertion":[{"value":"2025-11-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70133"}}