JACC. Case reports · 2026
Recurrent Torsades de Pointes Precipitated by Berberine Supplement.
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Mohammadi Abbas, Abdalla Hesham M, Falls Nicole, Tan Min Choon, Kanaan Christopher N, Sorajja Dan, Cannan Charles R, Sardana Mayank, El Masry Hicham Z
Аннотация
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.
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.