Drug-Induced Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with severe consequences, including symptoms, hemodynamic instability, increased cardiovascular mortality, and stroke. While other arrhythmias such as torsades de pointes and sinus bradycardia are more typically thought of as drug-induced, AF may also be precipitated by drug therapy, although ascribing causality to drug-associated AF is more difficult than with other drug-induced arrhythmias. Drug-induced AF is more likely to occur in patients with risk factors and comorbidities that commonly coexist with AF, such as advanced age, alcohol consumption, family history of AF, hypertension, thyroid dysfunction, sleep apnea, and heart disease. New-onset AF has been associated with cardiovascular drugs such as adenosine, dobutamine, and milrinone. In addition, medications such as corticosteroids, ondansetron, and antineoplastic agents such as paclitaxel, mitoxantrone, and anthracyclines have been reported to induce AF. Whether bisphosphonate drugs are associated with new onset AF remains controversial and requires further study. The potential contribution of specific drug therapy should be considered when patients present with new onset AF.

Relation Between Cancer and Atrial Fibrillation (from the REasons for Geographic And Racial Differences in Stroke Study)

“…19 Also, the development of AF possibly represents a complication of medical cancer therapy as numerous chemotherapeutic agents are associated with AF arrhythmiogenesis. 20 However, our study was unable to determine the underlying mechanisms for this association and further research is needed to explore these hypotheses.…”

European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS)

“…187,189,193 Adenosine is reported to induce AF when used for terminating supraventricular tachycardia with atrioventricular nodal involvement. Many patients undergoing cardiac surgery and treated with the inotrope dobuta-mine may develop post-operative AF.…”

“…Evidence of chemotherapy-induced AF has been summarized. 187,188 Anthracyclines, melphalan, interleukin-2, and cisplatin appear to be associated with AF, in addition to cancer itself that creates an inflammatory arrhythmogenic milieu. 194 Several case reports of antipsychotic drugs associated with AF have been published, 192 include with olanzapine (used for the treatment of schizophrenia and bipolar disorder).…”

Drug-Induced Cardiovascular Adverse Events in the Intensive Care Unit

“…Epinephrine, dopamine, and norepinephrine all affect β 1 receptors with norepinephrine having the least effect. 18 Some bronchodilators used in the ICU that stimulate β 2 receptors in the lungs also stimulate β 1 receptors in the heart. Studies have shown that the incidence and degree of tachycardia are increased with escalating doses and longer duration of vasopressor therapy.…”

“…Studies have shown that the incidence and degree of tachycardia are increased with escalating doses and longer duration of vasopressor therapy. 18 Albuterol has been linked to tachycardia but has rarely been implicated in causing atrial fibrillation. These include dobutamine, albuterol, and theophylline.…”