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 <i>Cassia alata</i> (candle bush), further investigation revealed that the tincture was instead prepared from <i>Aconitum</i> 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.