Carbamazepine
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Reactions 465 - 21 Aug 1993 S Carbamazepine Heart disorders in a patient with a cardiac pacing device: case report A 59-year-old man experienced an abrupt increase in stimulation threshold causing failure of his functioning pacemaker after 5 days’ treatment with carbamazepine [dosage not given] for mania. A permanent dual-chamber pacemaker was implanted in the man, because of complete heart block following an aortic valve replacement operation. On admission, his ECG revealed that atrial and ventricular stimuli were ineffective without sensory failure. Atrial and ventricular capture occurred when atrial and ventricular pulse amplitudes were raised to 5 volts. The plasma carbamazepine concentration was 21 µmol/L. Carbamazepine treatment was continued and the patient received a heart transplant 2 months later. Examination of the heart revealed no evidence of myocardial infarction, cellular hypertrophy and mild myocardial fibrosis. Author comment: ‘The elevation of ventricular and atrial thresholds after carbamazepine accords with observations that the drug has class I antiarrhythmic properties. This class increases myocardial stimulation threshold. Attention should be paid to stimulus amplitude in patients with pace-makers before starting carbamazepine.’ Ambrosi P, et al. Carbamazepine and pacing threshold. Lancet 342: 365, 7 Aug 1993 - France 800214575 1 Reactions 21 Aug 1993 No. 465 0114-9954/10/0465-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 465 - 21 Aug 1993
SCarbamazepine
Heart disorders in a patient with a cardiac pacingdevice: case report
A 59-year-old man experienced an abrupt increase instimulation threshold causing failure of his functioningpacemaker after 5 days’ treatment with carbamazepine[dosage not given] for mania. A permanent dual-chamberpacemaker was implanted in the man, because of completeheart block following an aortic valve replacement operation.
On admission, his ECG revealed that atrial and ventricularstimuli were ineffective without sensory failure. Atrial andventricular capture occurred when atrial and ventricular pulseamplitudes were raised to 5 volts. The plasma carbamazepineconcentration was 21 µmol/L.
Carbamazepine treatment was continued and the patientreceived a heart transplant 2 months later. Examination of theheart revealed no evidence of myocardial infarction, cellularhypertrophy and mild myocardial fibrosis.
Author comment: ‘The elevation of ventricular and atrialthresholds after carbamazepine accords with observations thatthe drug has class I antiarrhythmic properties. This classincreases myocardial stimulation threshold. Attention shouldbe paid to stimulus amplitude in patients with pace-makersbefore starting carbamazepine.’Ambrosi P, et al. Carbamazepine and pacing threshold. Lancet 342: 365, 7 Aug1993 - France 800214575
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Reactions 21 Aug 1993 No. 4650114-9954/10/0465-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
