Atrioventricular block related to liposomal amphotericin B

Abstract

Atrioventricular block can occur in normal children, young adults or athletes. It is also associated with underlying heart disease or occurs as a drug adverse effect. Amphotericin B is used in the treatment of invasive fungal infections. Cardiac toxicity is a rare adverse reaction. We report the case of a 9-month girl, admitted in the paediatric intensive care unit with cytomegalovirus pneumonitis. During hospitalisation the patient developed a systemic fungic infection and was medicated with liposomal amphotericin B. On the third day of treatment she began repeated episodes of bradycardia with spontaneous reversion. The investigation revealed a second-degree atrioventricular block. We excluded the misplacement of the central catheter, myocarditis or structural cardiomyopathy and suspended amphotericin. After 8 days, the bradycardia episodes ceased what was consistent with the drug's half-life. Amphotericin cardiotoxic mechanism is still unclear. It may be related with alteration of myocardial membrane depolarisation.

Asystolic cardiac arrest following liposomal amphotericin B infusion: anaphylaxis or compliment activation-related pseudoallergy?

“…Since then, a review of the literature has identified nine reports of anaphylaxis or cardiac toxicity attributed to LAmB (Table 1). Of note, all the cases of cardiac toxicity appeared to be dose and time dependent (occurring only after multiple sequential doses) and were associated with hyperkalaemia [8][9][10][11], for which amphotericin B has been assigned a "black box warning, " however our case was normokalaemic at the time of event. Three of the reported cases of LAmB anaphylaxis were administered conventional amphotericin B either prior to or following LAmB without reaction [12][13][14], suggesting allergic reaction to the liposome or other excipients.…”

Myocardial Cell Preservation from Potential Cardiotoxic Drugs: The Role of Nanotechnologies

“…Different formulations reflect different pH, viscosity, surface tension, and osmolality. Amphotericin B rarely causes cardiac involvement, but when it does, critical cardiomyopathies and arrhythmias may develop [ 111 , 112 ]. The above new drug preparations may help reduce toxic side effects, especially in bedridden patients with frequent cardiovascular comorbidities.…”

Non‐occlusive ST‐segment elevated myocardial infarction following the administration of liposomal amphotericin B in the treatment of cryptococcal meningitis

“…However in our patient, blood pressure was normal at the time of the STEMI. Other post‐marketing cardiotoxicity‐related events include reversible dilated cardiomyopathy, atrioventricular block and ventricular arrhythmias, including torsades de pointes …”