Multimodal Management of Refractory Ventricular Tachycardia Due to Aconitine Poisoning: A Case Report in a Resource-Limited Setting.

Aconitine, a potent plant alkaloid used in traditional Asian medicine, possesses significant toxicity risks. This case report presents a 42-year-old male with alcohol use disorder who developed life-threatening ventricular tachycardia after ingesting a homemade herbal liqueur. Initially thought to contain Cassia alata (candle bush), further investigation revealed that the tincture was instead prepared from Aconitum root (Wolfsbane) based on advice from an online social media video. He subsequently developed life-threatening ventricular tachycardia and cardiac arrest refractory to initial interventions. In the absence of extracorporeal membrane oxygenation (ECMO), flecainide, or procainamide, a multimodal approach involving multiple antiarrhythmics, including amiodarone, phenytoin, and stellate ganglion block, ultimately restored normal sinus rhythm. This case underscores the importance of early recognition and a flexible, multimodal treatment strategy in managing aconitine-induced arrhythmias, especially in resource-limited settings.