Atrial fibrillation induced by gabapentin: a case report

Abstract

Background Gabapentin is commonly prescribed for the treatment of neuropathic pain, restless leg syndrome, and partial-onset seizures. Although the most frequent side effects of gabapentin are associated with the central nervous system, gabapentin can also affect the cardiovascular system. Case reports and observational studies have showed that gabapentin can be associated with increased risk of atrial fibrillation. However, all the evidence is concentrated in patients older than 65 years old with comorbidities that predispose them to the development of arrhythmias. Case presentation We describe a case of an African American male in his 20s that presented to our chronic pain clinic with lumbar radiculitis and developed atrial fibrillation 4 days after being started on gabapentin. Laboratory workup did not show significant abnormalities, including normal complete blood count, comprehensive metabolic panel, toxicology screen, and thyroid-stimulating hormone. Transthoracic and transesophageal echocardiography showed a patent foramen ovale with right-to-left shunt. The patient was initially treated with diltiazem for heart rate control and apixaban. Direct current cardioversion with successful conversion to sinus rhythm was performed 24 hours after admission. The patient was then discharged on apixaban and diltiazem. Apixaban was changed to low-dose aspirin 1 month after discharge. Conclusion With rapidly increasing usage of gabapentin for approved and off-label indications, it is important to identify unintended adverse effects of this drug as they are considered safe alternatives to opioids. New-onset atrial fibrillation could be induced by gabapentin in young individuals.

Effects of Acute and Chronic Gabapentin Treatment on Cardiovascular Function of Rats

“…There are no clinical studies to have investigated the side effects or toxicity of GBP on cardiovascular function, however, several case reports describe adverse cardiovascular events induced by GBP or its structurally similar compound, pregabalin. These include the development of new onset congestive heart failure [10,11], decompensation of pre-existing CHF [21][22][23], cardiac conduction disturbances [24,25], atrial fibrillation [9], and hypotension [13,26]. In an analysis of a large-scale nation-wide database of de-identified patients (TriNetZ EHRs), Pan et al [8] recently found a significant increase in the risk of cardiovascular diseases, including heart failure, myocardial infarction, peripheral vascular disease, stroke, deep venous thrombosis, and pulmonary embolism in patients with diabetic neuropathy following long-term use of GBP and pregabalin.…”

“…Indeed, a retrospective cohort study revealed a significantly increased risk of adverse cardiovascular events, including heart failure, myocardial infarction, peripheral vascular disease, stroke, deep venous thrombosis, and pulmonary embolism in patients with diabetic neuropathy following long-term use of GBP [8]. Furthermore, several clinical cases of GBP-induced atrial fibrillation [9], acute heart failure [10,11], cardiomyopathy [12], and intraoperative hypotension [13] have been reported recently. Thus, we postulate that these events may be attributed, in part, to the effects of GBP on Ca 2+ currents in cardiomyocytes or vascular smooth muscles.…”

Effects of Acute and Chronic Gabapentin Treatment on Cardiovascular Function of Rats

“…There are no clinical studies to have investigated the side effects or toxicity of GBP on cardiovascular function, however, several case reports describe adverse cardiovascular events induced by GBP or its structurally similar compound, pregabalin. These include the development of new onset congestive heart failure [10,11], decompensation of pre-existing CHF [21][22][23], cardiac conduction disturbances [24,25], atrial fibrillation [9], and hypotension [13,26]. In an analysis of a large-scale nation-wide database of de-identified patients (TriNetZ EHRs), Pan et al [8] recently found a significant increase in the risk of cardiovascular diseases, including heart failure, myocardial infarction, peripheral vascular disease, stroke, deep venous thrombosis, and pulmonary embolism in patients with diabetic neuropathy following long-term use of GBP and pregabalin.…”

“…Indeed, a retrospective cohort study revealed a significantly increased risk of adverse cardiovascular events, including heart failure, myocardial infarction, peripheral vascular disease, stroke, deep venous thrombosis, and pulmonary embolism in patients with diabetic neuropathy following long-term use of GBP [8]. Furthermore, several clinical cases of GBP-induced atrial fibrillation [9], acute heart failure [10,11], cardiomyopathy [12], and intraoperative hypotension [13] have been reported recently. Thus, we postulate that these events may be attributed, in part, to the effects of GBP on Ca 2+ currents in cardiomyocytes or vascular smooth muscles.…”