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Second-line antiarrhythmic therapies failed to reduce the recurrent deterioration to malignant ventricular rhythms. Progression to extracorporeal support was avoided by the use of a titrated esmolol infusion. We discuss the physiological rationale by which esmolol may prevent tachyarrhythmia and fibrillation in severe amitriptyline toxicity.<\/jats:p>","DOI":"10.1136\/bcr-2021-248373","type":"journal-article","created":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T11:26:21Z","timestamp":1658489181000},"page":"e248373","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Esmolol for intractable ventricular arrhythmias in major amitriptyline toxicity"],"prefix":"10.1136","volume":"15","author":[{"given":"Peter","family":"Garrett","sequence":"first","affiliation":[{"name":"Intensive Care, Sunshine Coast University Hospital, Birtinya, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Klupfel","sequence":"additional","affiliation":[{"name":"Intensive Care, Sunshine Coast University Hospital, Birtinya, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,7,22]]},"reference":[{"key":"2025082711075381000_15.7.e248373.1","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1097\/MEJ.0b013e328334a98f","article-title":"Brugada-like ECG pattern induced by tricyclic antidepressants","volume":"17","author":"Meert","year":"2010","journal-title":"Eur J Emerg Med"},{"doi-asserted-by":"publisher","key":"2025082711075381000_15.7.e248373.2","DOI":"10.1111\/j.1540-8167.2011.02196.x"},{"doi-asserted-by":"publisher","key":"2025082711075381000_15.7.e248373.3","DOI":"10.2165\/00139709-200524030-00013"},{"doi-asserted-by":"publisher","key":"2025082711075381000_15.7.e248373.4","DOI":"10.1016\/0002-8703(82)90281-2"},{"doi-asserted-by":"publisher","key":"2025082711075381000_15.7.e248373.5","DOI":"10.1097\/00005344-198401000-00012"},{"key":"2025082711075381000_15.7.e248373.6","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1161\/01.CIR.72.4.898","article-title":"Frequency-Dependent effects of amitriptyline on ventricular conduction and cardiac rhythm in dogs","volume":"72","author":"Nattel","year":"1985","journal-title":"Circulation"},{"key":"2025082711075381000_15.7.e248373.7","doi-asserted-by":"crossref","first-page":"177","DOI":"10.3109\/15563659109038610","article-title":"Plasma catecholamine levels in cyclic antidepressant overdose","volume":"29","author":"Merigian","year":"1991","journal-title":"J Toxicol Clin Toxicol"},{"doi-asserted-by":"publisher","key":"2025082711075381000_15.7.e248373.8","DOI":"10.1111\/j.1742-7843.2005.pto960206.x"},{"key":"2025082711075381000_15.7.e248373.9","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1097\/00005344-199312000-00004","article-title":"Mechanisms of ventricular arrhythmia during amitriptyline toxicity","volume":"22","author":"Ansel","year":"1993","journal-title":"J Cardiovasc Pharmacol"},{"doi-asserted-by":"publisher","key":"2025082711075381000_15.7.e248373.10","DOI":"10.1161\/01.CIR.68.4.846"},{"key":"2025082711075381000_15.7.e248373.11","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/00005344-199408000-00009","article-title":"Prevention of tricyclic antidepressant-induced ventricular tachyarrhythmia by a specific bradycardic agent in a canine model","volume":"24","author":"Ansel","year":"1994","journal-title":"J Cardiovasc Pharmacol"},{"doi-asserted-by":"publisher","key":"2025082711075381000_15.7.e248373.12","DOI":"10.1038\/clpt.1980.85"},{"unstructured":"TOXBASE . 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