Objective To report a case of atrial fibrillation (AF) due to oral methylprednisolone. Case Summary A 45-year-old white man with chronic intermittent paroxysmal supraventricular tachycardia (PSVT) reacted to oral methylprednisolone by developing a PSVT episode that elicited an 18-hour episode of AF. AF was resolved by discontinuing methylprednisolone and administering oral nadolol, and no recurrence was reported for 6 years. Discussion This appears to be the first published report linking AF to oral methylprednisolone. Based on an analysis of the literature, it is suggested that AF may be triggered by any autonomic paroxysmal event in some individuals. Accepting the clinical evidence linking methylprednisolone to PSVT, the case is elaborated as having involved an initial atrial paroxysmal reaction to the drug, which then triggered AF. Conclusions Clinicians may wish to consider history of arrhythmias, and to monitor them, when prescribing oral methylprednisololne.

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