Efficacy of Aminophylline for Treatment of Recurrent Symptomatic Bradycardia After Spinal Cord Injury

Abstract

Cardiac dysrhythmias and cardiac arrest can occur after acute spinal cord injury (SCI). Disrupted sympathetic innervation after SCI results in unopposed parasympathetic activity leading to baseline bradycardia. Hence, vagal stimulation can result in episodes of exaggerated symptomatic bradycardia. Data supporting pharmacologic intervention for treatment of symptomatic bradycardia after SCI are limited. We describe a patient who sustained a high cervical SCI and subsequently developed episodic symptomatic bradycardia. The addition of aminophylline to the patient's therapeutic regimen was associated with resolution of the bradycardia. Throughout her treatment course, the patient's serum theophylline concentrations were 1.9-3.4 mg/L. These levels were consistent with those identified in other case reports describing treatment with methylxanthines to prevent episodic bradycardia after SCI. Our understanding of drug pharmacokinetics and pharmacodynamics in patients with acute SCI is limited and provides an ideal opportunity for further study in this area.

Oral albuterol to treat symptomatic bradycardia in acute spinal cord injury

“…A number of case reports have been published suggesting that the xanthine derivatives, amiophylline and theophylline, may effectively ameliorate symptomatic bradycardia [6,13,16,17]. There are some disadvantages of using the xanthine derivatives.…”

Theophylline for Bradycardia Secondary to Cervical Spinal Cord Injury

“…In another report, a patient with cervical SCI developed recurrent episodes of symptomatic bradycardia requiring repeated doses of atropine and was successfully treated with per tube aminophylline [8].…”

Bradycardia Secondary to Cervical Spinal Cord Injury

“…Atropine improves conduction through the atrioventricular (AV) node by reducing vagal tone through muscarinic receptor blockade. The dose ranges from 0.4 to 0.6 mg, administered intravenously every 4 hours for short-term therapy (Abd & Braun, 1989;Pansoori & Leesar, 2004;Piepmeier et al, 1985;Sadaka et al, 2010;Sakamoto et al, 2007;Schulz-Stubner, 2005;Weant et al, 2007;Whitman et al, 2008;Winslow et al, 1986). Atropine should be kept readily available at the bedside at all times with this patient population, as acute episodes of bradycardia and hypotension may occur suddenly and without warning in the immediate few hours and days following injury.…”

“…Complications of permanent pacemakers include infection, lead malfunction, death during attempted insertion, and death associated with failure to capture. The methylxanthine agents, including aminophylline and theophylline, have been used effectively for the management of refractory symptomatic bradycardia when other agents have failed (Pansoori & Leesar, 2004;Sadaka et al, 2010;Sakamoto et al, 2007;SchulzStubner, 2005;Weant et al, 2007;Whitman et al, 2008). In addition, there are recent reports of methylxanthines used specifically as a successful first line treatment for bradycardia associated with cervical spinal cord injury.…”

“…Nonetheless until more experience is gained with this modality, careful attention should be made to monitor drug levels and avoid toxicity. Methylxanthine has also been associated with diaphragmatic strengthening in animal models, another potential beneficial effect to consider in spinal cord injury patients (Whitman et al, 2008). In patients requiring long-term therapy, there are case reports of successful treatment with propantheline 7.5 to 30 mg every 4 to 6 hours (Abd & Braun, 1989;Winslow et al, 1986).…”