Acute effect of zoledronic acid infusion on atrial fibrillation development in patients with osteoporosis

Abstract

Objective:There is ongoing controversy related to the relationship between bisphosphonates and atrial fibrillation (AF). Our aim in this study was to evaluate the potential acute effect of zoledronic acid (ZA) infusion on AF development by using 24-hour Holter recordings.Methods:The study was designed to be a self-controlled case series study, and 33 consecutive patients with osteoporosis (29 females, age: 62.3±9.0 years) who were scheduled to receive ZA infusion constituted the study population. Patients underwent 24-hour Holter rhythm recordings at two different times; the first one was 48 hours before the planned ZA infusion, and the second one was on the morning of the infusion day. Heart rate, frequency and type of arrhythmias, as well as heart rate variability (HRV) from the two recordings were compared.Results:There were no episodes of AF greater than 30 sec in any of the 24-hour Holter recordings obtained before and on the day of drug infusion. Holter recordings before drug infusion showed that only 1 patient had an atrial run of 3 beats long. Holter recordings obtained on the day of drug infusion revealed that 5 patients (15.2%) had atrial runs with lengths ranging between 3 and 12 beats (p=0.046). Regarding HRV variables, SDANN values were found to be significantly depressed on the day of ZA infusion (113.6±26.9 vs. 98.2±29.9, p=0.007).Conclusion:None of the patients developed AF during or early after ZA infusion. However, there was an increase in atrial ectopy in some patients, which might be due to alterations in cardiac autonomic activity.

Bisphosphonates and atrial fibrillation: revisiting the controversy

“…For instance, there was no increase in AF after zoledronic acid infusion in osteoporotic females despite an increase in atrial ectopy, which may be attributed to increased heart rate variability secondary to anxiety upon cannulation and infusion. 59 Furthermore, P wave dispersion and parameters of ventricular recovery were not changed either on the day of or 1 month after zoledronic acid infusion in osteoporotic female patients, despite an increase in QT intervals on the day of infusion. 60 Thus, results from epidemiological studies, summarized in Table 2, and electrocardiographic human studies highlight uncertainty surrounding the question of whether BPs are a causal factor in the incidence of AF in patients who receive them.…”

A Single-Center Prospective Study of 116 Women with Osteoporosis Treated with Zoledronic Acid Monitored by Electrocardiography for the Development of Cardiac Arrhythmia During the Acute Phase in China

“…The potential mechanisms of AF associated with bisphosphonate use include the arrhythmogenic effect by reducing serum levels of calcium and phosphate, release of proinflammatory cytokines, and influence on atrial remodeling by inducing zinc-dependent matrix metalloproteinases [ 12 , 13 ]. To study the direct cause-effect relationship between ZA usage and AF, İlgezdi et al [ 14 ] used 24-h Holter monitoring systems to evaluate the acute effects of ZA infusion on the risk of cardiac arrhythmia and observed no episodes of AF in any patient on the day of ZA infusion. However, atrial ectopy increased in 5 patients, which might be related to alterations in cardiac autonomic activity.…”

Clinical Efficacy and Safety of Zoledronic Acid Combined with PVP/PKP in the Treatment of Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…However, the side effects were quite well tolerated, as symptoms disappeared after symptomatic treatment or naturally within 3 days. Severe complications, such as osteonecrosis of the jaw [ 45 ] and atrial fibrillation [ 46 ], were not observed. Additionally, ZA had no effect on postoperative leakage.…”