CASE PRESENTATION: The patient developed refractory torsade de pointes (TdP) and required veno-arterial extracorporeal membrane oxygenation. His TdP resolved 7 h after arrival, with sinus rhythm returning within 12 h. The patient was discharged 6 days later. Subsequent measurements of the four alkaloids over time showed that jesaconitine had the highest serum concentration, with the patient's sinus rhythm returning when the jesaconitine concentration was less than 1 ng/mL. CONCLUSION: This report provides valuable insights into the disposition of aconitine alkaloids during severe intoxication. The changes in jesaconitine concentrations over time correlate with clinical symptoms, suggesting that these levels could guide treatment decisions in patients with severe