Holter Electrocardiogram Monitoring in Nephrotic Patients during Methylprednisolone Pulse Therapy

Abstract

We assessed the effect of intravenous methylprednisolone pulse therapy (IMPT) on cardiac rhythm and electrolyte metabolism in patients with nephrotic syndrome. A total of 25 patients had valid evaluations with continuous ambulatory electrocardiograms, and 20 of these had simultaneous sodium and potassium clearances. No significant difference of frequency in complex ventricular arrhythmias (Lown’s grades 3–5) between the control and the therapy period was observed; however, 4 patients showed complex ventricular arrhythmias including ventricular tachycardia (2 patients) during the course of therapy. Fractional excretion of potassium and serum potassium significantly increased from baseline after IMPT. Complex ventricular arrhythmias, sometimes leading to sudden death, might ensue from IMPT. These dysrhythmias may be related to an abrupt change in potassium reflux from the cell.

Atrial Flutter Versus Atrial Fibrillation in a General Population: Differences in Comorbidities Associated With Their Respective Onset

“…One mechanism by which steroids facilitate arrhythmogenesis is via a direct effect on the cell membrane causing potassium efflux from cells. 22 Theophylline has also been shown to be associated with AF among patients with COPD, interestingly even with normal serum levels. 23 Theophylline has been shown to decrease the atrioventricular and sinoatrial conduction time significantly while increasing the serum concentration of epinephrine and nor-epinephrine.…”

Hydrocortisone induce bradyarrhythmias: a case report

“…Although mechanism of such arrhythmia is unknown but postulated mechanisms are altered sensitivity of SA node to catecholamine or altered threshold of myocytes due to electrolyte shift across cell membrane. 4,5 Reflex bradycardia due to increased blood pressure and plasma volume expansion or any reaction to steroid preparations are some other proposed mechanisms for steroid induced bradycardia. 6 In our patient, complete cardiac evaluation was normal and all the changes were reverted once hydrocortisone was stopped.…”

Atrial Fibrillation Due to Oral Methylprednisolone in a Patient with Membranoproliferative Glomerulonephritis

“…It was postulated that MPZ mediates calcium and potassium flux across cell membranes (1,4). The linkage of corticosteroids and arrhythmia via potassium efflux seems a sufficient explanation for the effects of high dose pulse therapy (6,7,8,10).…”