Kratom-Associated Ventricular Fibrillation

Cardiac arrest refers to the sudden loss of myocardial contractility in a person who may or may not have been previously diagnosed with heart disease. It can be caused by several disorders such as arrhythmias, acute coronary syndrome, cardiomyopathies, respiratory disease, metabolic disorders, recreational drug abuse, and medication overdose as well as additional etiologies. The estimated incidence of out-of-hospital cardiac arrest (OHCA) in the United States is more than 350,000 yearly. Of those who experience OHCA, 70%–90% die before reaching the hospital, and OHCA carries a significantly worse prognosis than in-hospital cardiac arrest.1 Among teens and young adults experiencing OHCA, recreational drug use is a common predisposing factor. Kratom is an herbal product obtained from leaves of the kratom tree (Mitragyna speciosa). The kratom tree is indigenous to parts of Thailand, Malaysia, Indonesia, Papua New Guinea, and other Southeast Asian countries. For those living in western countries, it is mainly ordered through the Internet and is not yet an illegal substance. Currently, there appears to be an increasing prevalence of kratom use in the United States despite warnings from the FDA about the risks of addiction, abuse, dependence, and the possible side effects of this product.2 In this case, a young adult patient who experienced OHCA in the setting of known kratom use is discussed.