Three cases of corticosteroid therapy triggering ventricular fibrillation in J-wave syndromes

Naka, Sadahiro; Sato, Nobuyuki; Goto, Masahide; Kobayashi, Michie; Takehara, Naofumi; Takeuchi, Toshiharu; Talib, Ahmed Karim; Sugiyama, Eitaro; Minoshima, Akiho; Tanabe, Yasuko; Akasaka, Keiichi; Kawabe, Jun‐ichi; Kawamura, Y.; Doi, Atsushi; Hasebe, Naoyuki

doi:10.1007/s00380-013-0443-x

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…Documented dyselectrolytemia was reported in a few cases. [ 6 7 ] In our case, the patient did not have dyselectrolytemia and infusion was given slowly over 4 hours. Our patient was not also on any other medication during this period.…”

Section: Discussionmentioning

confidence: 83%

Bradycardia after pulse methylprednisolone therapy in a child—Uncommon side effect of a frequently used drug: A case report

Tripathy

Das

Malik

2023

Journal of Family Medicine and Primary Care

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A BSTRACT Corticosteroids are potent anti-inflammatory agents used as a mainstay of therapy in most of the rheumatologic disorders. Common side effects of pulse steroid therapy include hypertension, hyperglycemia, seizure, hypokalemia, and infection. We report a case of an 11-year-old girl with polyarticular Juvenile idiopathic arthritis who developed bradycardia following pulse methylprednisolone therapy. On day 2 of methylprednisolone infusion, she developed bradycardia with a heart rate between 50 and 60/min. ECG was suggestive of sinus bradycardia. There was no evidence of dyselectrolytemia (Na—141 mmol/l, K—3.54 mmol/l, Ca—8.72 mg/l) or sepsis. The patient did not receive methylprednisolone on day 3 and vitals continued to be monitored. Her heart rate improved after 12 hours. In the mid of infusion on day 4, again the patient had bradycardia with a heart rate of 50–60/minute. Since she was hemodynamically stable, we continued the infusion, and bradycardia resolved in the next 8 hours. On follow-up after 2 weeks, she had some improvement in joint symptoms and normal heart rate. As per Naranjo adverse drug reaction probability scale, the adverse reaction in our case was probable with a score of 8. Although bradycardia associated with pulse steroid therapy is benign and is usually reversible following cessation of therapy, a baseline heart rate, ECG, and electrolyte level are suggested before infusion as a cautionary measure to minimize serious adverse events.

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Section: Discussionmentioning

confidence: 83%

Bradycardia after pulse methylprednisolone therapy in a child—Uncommon side effect of a frequently used drug: A case report

Tripathy

Das

Malik

2023

Journal of Family Medicine and Primary Care

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“…Finally, it is important to bear in mind pro‐arrhythmic effects of some agents used for treatment of AD patients. Steroid therapy may induce various arrhythmias 11,12 by direct action on membrane potassium channels and their expression, 13 whereas cytostatic drugs may induce various arrhythmias by reduced coronary flow, associated ischemia, or/and inhibition of sodium‐calcium exchange 14 . Cisplatin is associated with a very high rate of AF (12‐32%) similarly to anthracyclines (2‐10%).…”

Section: Discussionmentioning

confidence: 99%

Management of cardiac arrhythmias in patients with autoimmune disease—Insights from EHRA Young Electrophysiologists

Gawałko

Peller

Balsam

et al. 2020

Pacing Clinical Electrophis

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Background: Since arrhythmia treatment in patients with autoimmune disease (AD) is challenging, we aimed to assess the common "real-world" practice in the electrophysiology centers. Methods: Twenty-four young electrophysiologists being part of European Heart Rhythm Association filled questionnaire regarding arrhythmia management in AD. Results: Rheumatoid arthritis was the most commonly reported AD accompanied by cardiac arrhythmias. The most frequent observed arrhythmias were atrial fibrillation and premature atrial/ventricular contractions. Most often electrocardiographic abnormalities observed were increased heart rate variability, QT interval prolongation, and P-wave dispersion, whereas echocardiographic abnormalities included left atrial enlargement, pericardial infusion, and left ventricular dysfunction. The most useful tool for arrhythmia management was guidelines and evidence-based medicine, while training courses and websites were at least useful. A close collaboration with other specialists in arrhythmia management was reported in 58.3% of respondents. Glucocorticoids and cytostatic were the most reported arrhythmia-induced drugs, whereas amiodarone and beta-blockers were most effective antiarrhythmic drugs. The main reason that discouraged respondents from cardiac implantable devices implantation and catheter ablation was high infection complications risk and recurrences during long-term follow-up, respectively. Conclusions: Scant data and guidelines enforce exchange of experience to improve the arrhythmia treatment in AD.

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Section: Discussionmentioning

confidence: 99%

“…Corticosteroid, especially for steroid pulse therapy, can induce cardiac arrhythmias, such as tachyarrhythmias and bradyarrhythmias [2,22]. From the basic electrophysiologic viewpoint, corticosteroids affect cardiac calcium channels and also potassium channels [22]. A case of hypokalemia occurred after starting injection methylprednisolone in the rheumatoid patient and resolved after its withdrawal [7].…”

Section: Discussionmentioning

confidence: 99%

Methylprednisolone Induced Hypokalemia in an Idiopathic Thrombocytopenic Purpura (Itp) Patient

Arrang

Cokro

2020

Int J Pharm Pharm Sci

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We reported an Idiopathic Thrombocytopenic Purpura (ITP) patient, 66-years-old (woman), with hypokalemia. She received 125 mg three times daily of methylprednisolone injection for her ITP. Corticosteroids are the initial treatment of ITP. Her potassium level decrease after she took methylprednisolone. Hypokalemia is also a common problem affecting the elderly or geriatric population. Many literatures reported side effects of corticosteroid is associated with hypokalemia. Monitoring potassium levels must be check during corticosteroid therapy. In this report, we describe the association between corticosteroid with hypokalemia effect.

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Three cases of corticosteroid therapy triggering ventricular fibrillation in J-wave syndromes

Cited by 9 publications

References 18 publications

Bradycardia after pulse methylprednisolone therapy in a child—Uncommon side effect of a frequently used drug: A case report

Bradycardia after pulse methylprednisolone therapy in a child—Uncommon side effect of a frequently used drug: A case report

Management of cardiac arrhythmias in patients with autoimmune disease—Insights from EHRA Young Electrophysiologists

Methylprednisolone Induced Hypokalemia in an Idiopathic Thrombocytopenic Purpura (Itp) Patient

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