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Kawabata M, Yokoyama Y, Sasaki T, et al. Severe iatrogenic bradycardia related to the combined use of beta-blocking agents and sodium channel blockers. Clin Pharmacol. 2015;7:29-36doi: 10.2147/CPAA.S77021.
Kawabata, M., Yokoyama, Y., Sasaki, T., Tao, S., Ihara, K., Shirai, Y., Sasano, T., Goya, M., Furukawa, T., Isobe, M., & Hirao, K. (2015). Severe iatrogenic bradycardia related to the combined use of beta-blocking agents and sodium channel blockers. Clinical pharmacology : advances and applications, 729-36. https://doi.org/10.2147/CPAA.S77021
Kawabata, Mihoko, et al. "Severe iatrogenic bradycardia related to the combined use of beta-blocking agents and sodium channel blockers." Clinical pharmacology : advances and applications vol. 7 (2015): 29-36. doi: https://doi.org/10.2147/CPAA.S77021
Kawabata M, Yokoyama Y, Sasaki T, Tao S, Ihara K, Shirai Y, Sasano T, Goya M, Furukawa T, Isobe M, Hirao K. Severe iatrogenic bradycardia related to the combined use of beta-blocking agents and sodium channel blockers. Clin Pharmacol. 2015 Feb 16;7:29-36. doi: 10.2147/CPAA.S77021. eCollection 2015. PMID: 25733934; PMCID: PMC4337503.
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Clin Pharmacol. 2015 Feb 16;7:29-36. doi: 10.2147/CPAA.S77021. eCollection 2015.

Severe iatrogenic bradycardia related to the combined use of beta-blocking agents and sodium channel blockers.

Clinical pharmacology : advances and applications

Mihoko Kawabata, Yasuhiro Yokoyama, Takeshi Sasaki, Susumu Tao, Kensuke Ihara, Yasuhiro Shirai, Tetsuo Sasano, Masahiko Goya, Tetsushi Furukawa, Mitsuaki Isobe, Kenzo Hirao

Affiliations

  1. Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
  2. Department of Biofunctional Informatics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
  3. Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
  4. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.

PMID: 25733934 PMCID: PMC4337503 DOI: 10.2147/CPAA.S77021

Abstract

PURPOSE: Drug-induced bradycardia is common during antiarrhythmic therapy; the major culprits are beta-blockers. However, whether other antiarrhythmic drugs are also a significant cause of this, alone or in combination with beta-blockers, is not well known.

METHODS: We retrospectively investigated the records of all patients hospitalized at our institution for drug-related bradycardia from the years 2004 to 2012. Patients with cardiac disease and electrolytic or hormonal abnormalities that could cause bradyarrhythmias were excluded.

RESULTS: Eight patients were identified (mean age, 79±5 years; range, 71-85 years; 6 women). Three patients were taking only beta-blockers (hereafter referred to as the BB group), while five patients were on both beta-blockers and Na channel blockers (hereafter referred to as the BB + Na group). Heart rates ranged from 20∼49 beats/minute on arrival. The initial electrocardiogram showed sinus bradycardia (n=6) or sinus arrest with escape beats (n=2). QRS duration was 80-100 ms. The clinical presentation of the BB + Na group was considerably worse than that of the BB group, and included cardiogenic shock and heart failure. Four of the BB + Na patients had been on their medications for over 300 days. The BB group recovered solely with drug discontinuation, while 4 of the 5 patients in the BB + Na group needed additional treatments, such as intravenous administration of atropine or adrenergic agonist and temporary pacing. Bradycardia did not recur during follow-up (median, 687 days).

CONCLUSION: Although wide QRS ventricular tachyarrhythmia is a better known proarrhythmic effect of Na channel blockers, life-threatening bradycardia may also occur in combination with beta-blockers in the elderly, even months after the start of medication, and at plasma concentrations that do not prolong QRS width.

Keywords: QRS duration; elderly; proarrhythmia

References

  1. Circ Res. 2013 Aug 30;113(6):739-53 - PubMed
  2. Am J Med. 2013 Sep;126(9):805-810.e5 - PubMed
  3. Europace. 2000 Jan;2(1):54-9 - PubMed
  4. Am J Cardiol. 2003 Jun 15;91(12):1437-41 - PubMed
  5. Nat Med. 2009 Apr;15(4):380-3 - PubMed
  6. Ann N Y Acad Sci. 2002 Nov;976:513-9 - PubMed
  7. Am J Cardiol. 1998 Oct 16;82(8A):50N-58N - PubMed
  8. Proc Natl Acad Sci U S A. 2003 Mar 18;100(6):3507-12 - PubMed
  9. Ann Intern Med. 1997 Aug 15;127(4):281-4 - PubMed
  10. Annu Rev Med. 1979;30:91-118 - PubMed
  11. Life Sci. 1986 Oct 20;39(16):1465-70 - PubMed
  12. J Physiol. 2004 Sep 15;559(Pt 3):835-48 - PubMed
  13. Pacing Clin Electrophysiol. 2004 Aug;27(8):1144-7 - PubMed
  14. JAMA. 2003 Feb 12;289(6):712-8 - PubMed
  15. Korean Circ J. 2009 Sep;39(9):367-71 - PubMed
  16. Circ Res. 1980 Jan;46(1):11-22 - PubMed
  17. JAMA. 2000 Mar 8;283(10):1295-302 - PubMed
  18. Arch Int Pharmacodyn Ther. 1987 May;287(1):78-88 - PubMed
  19. Circ Arrhythm Electrophysiol. 2011 Apr;4(2):128-35 - PubMed
  20. Am J Cardiol. 1987 Jan 30;59(3):24B-29B - PubMed
  21. N Engl J Med. 1988 Aug 4;319(5):257-62 - PubMed
  22. Circ Res. 2001 Jun 22;88(12):1254-8 - PubMed
  23. Am J Physiol. 1997 Jun;272(6 Pt 2):H2793-806 - PubMed
  24. Jpn Heart J. 2000 May;41(3):405-10 - PubMed
  25. J Pharmacol Sci. 2006 Sep;102(1):7-16 - PubMed
  26. J Am Coll Cardiol. 1989 Jul;14(1):209-15; discussion 216-7 - PubMed
  27. J Am Coll Cardiol. 1998 Jul;32(1):169-76 - PubMed
  28. Am J Cardiol. 1987 Apr 30;59(11):26E-31E - PubMed
  29. Comp Biochem Physiol C. 1987;87(2):237-43 - PubMed
  30. Circulation. 1996 Nov 15;94(10):2535-41 - PubMed
  31. J Am Coll Cardiol. 2003 Jan 15;41(2):249-54 - PubMed

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