Chronotropic Effect of the Antithrombotic Agent Cilostazol in a Patient with Sick Sinus Syndrome and Syncope

Abstract

In this case report we describe an 80-yearold man with sick sinus syndrome (SSS) who developed syncope attacks. The diagnosis of SSS was based on electrocardiographic evidence of markedly prolonged sinus arrests associated with syncope attacks while in hospital. The patient was given cilostazol, an antithrombotic agent that selectively inhibits cyclic nucleotide phosphodiesterase type 3, at a dose of 100 mg twice daily. The syncope attacks ceased, and an electrocardiogram obtained 1 week after the start of cilostazol administration showed no evidence of sinus arrest. The outcome of this case suggests that cilostazol may be useful in patients with syncope attacks due to SSS, although the long-term chronotropic effects of cilostazol need to be evaluated.

Cilostazol ameliorates atrial ionic remodeling in long-term rapid atrial pacing dogs

“…Therefore, cilostazol may serve as an effective cardioprotective drug, with its beneficial effects in preventing arrhythmia. Investigations on the effects of cilostazol on heart rate variability (HRV) have shown that cilostazol significantly improves a slow heart rate (34, 35). However, it is important to note that the evidence regarding cilostazol and tachyarrhythmia is still limited and unclear.…”

The Blood Glucose Level Increased in Parallel with the Heart Rate Following Cilostazol Administration in Three Diabetic Patients

“…In this study, the heart rates of three patients increased after cilostazol use. Treatment with cilostazol was continued in Case 2 in anticipation of favorable chronotropic effects in patients with sinus bradycardia (18).…”

Long term effects of cilostazol in a dog with sick sinus syndrome

“…Cilostazol has positive chronotropic effects and has been used to treat human patients with bradyarrhythmias, such as atrioventricular (AV) block and SSS [2, 9, 10, 12, 15, 19]. Cilostazol has also been reported to have long-term chronotropic effects [5, 9].…”

“…In this case, although the patient exhibited premature beats, atrial fibrillation was not observed. In human patients, cilostazol is used until PMI can be performed and in patients unable to receive a pacemaker [5, 9, 10]. …”

“…To determine the dosage, we referenced a study with dogs and case reports of human patients with bradyarrhythmias [1, 2, 6, 7, 9,10,11, 14, 19]. The effects of both increased HR and decreased blood pressure are concentration-dependent [14].…”