Sequential Use of Aminophylline and Theophylline for Temporizing Neck Cancer-Induced Carotid Sinus Syncope

Tsushima, Takahiro; Badhwar, Anshul K.; Kalra, Ankur; Thal, Sergio; Mackall, Judith A.

doi:10.1016/j.jaccas.2019.09.017

Cited by 4 publications

(1 citation statement)

References 8 publications

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“…Although not widely employed, theophylline has shown to be effective in temporarily managing CSS in H&N cancer patients, eliminating the requirement for invasive pacemaker placement [ 17 ]. Theophylline acts as an adenosine receptor antagonist and phosphodiesterase inhibitor, thereby inhibiting the breakdown of cyclic AMP in smooth muscle cells.…”

Section: Discussionmentioning

confidence: 99%

Carotid Sinus Syndrome With Convulsive Syncope in a Patient With Head and Neck Cancer

Saparov,

Wasifusddin,

Hakobyan

et al. 2024

Cureus

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This case report provides a comprehensive overview of a unique case of a 64-year-old male patient with head and neck (H&N) cancer who initially presented with compressive convulsive syncope, an initial manifestation of carotid sinus syndrome (CSS). CSS is an autonomic nervous system disease that often manifests as hypotension, dizziness, cerebral ischemia, or syncope, usually in elderly patients. In this case, the patient's laryngeal cancer led to lymphedema and encasement of the bilateral carotid arteries, inducing CSS and resulting in recurrent episodes of hypotension and bradycardia. These symptoms were managed through the administration of atropine and transcutaneous pacemaker placement, suggesting a probable mixed type of CSS. The patient was discharged on long-term theophylline treatment for symptomatic control of bradycardia episodes. Despite the promising outcomes of CSS cases treated with pacemakers, the efficacy is not universal and limitations may arise, particularly in H&N cancer patients. Therefore, the patient was managed with theophylline rather than a pacemaker due to its non-invasiveness and effectiveness in temporarily managing CSS. Although rare, CSS should be considered in patients experiencing convulsive syncope alongside H&N malignancies. As the evidence and consensus regarding CSS treatment in H&N cancer patients are scarce, additional research is necessary to evaluate and compare available options. This abstract concludes by emphasizing the need for further research and case reports to establish a consensus on the optimal management approach for patients affected by CSS due to compression from H&N cancers.

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Section: Discussionmentioning

confidence: 99%

Carotid Sinus Syndrome With Convulsive Syncope in a Patient With Head and Neck Cancer

Saparov,

Wasifusddin,

Hakobyan

et al. 2024

Cureus

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Methylxanthine Derivatives in the Treatment of Sinus Node Dysfunction: A Systematic Review

Roth,

Reinert

2023

Cardiology in Review

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While the chronotropic effects of theophylline and aminophylline are well-known, their clinical application in the treatment of sinus node dysfunction has not been established in a review. The purpose of this systematic review is to evaluate the efficacy and safety of methylxanthines in the treatment of bradyarrhythmias associated with sinus node dysfunction. A systematic review was conducted in accordance with PRISMA guidelines on Embase, PubMed, MEDLINE, Cochrane Central, Web of Science, SciELO, Korean Citation Index, Global Index Medicus, and CINAHL through June 2023. A total of 607 studies were identified through the literature search. After applying the inclusion and exclusion criteria, 14 studies were included in this review. The causes of bradyarrhythmias involving the sinoatrial node included acute cervical spinal cord injury, coronavirus disease of 2019, carotid sinus syncope, chronotropic incompetence, heart transplant, and chronic sinus node dysfunction. Theophylline and aminophylline were shown to be effective for increasing heart rate and reducing the reoccurrence of bradyarrhythmias. The data on symptom resolution was conflicting. While many case studies reported a resolution of symptoms, a randomized controlled trial reported no significant difference in symptom scores between the control, theophylline, and pacemaker groups in the treatment of sick sinus syndrome. The incidence of adverse effects was low across all study designs. The data suggests methylxanthines may be useful as an alternative or bridge to nonpharmacologic pacing; however, dosing has yet to be established for various indications. Overall, methylxanthines proved safe and effective as a pharmacologic therapy for bradyarrhythmic manifestations of sinus node dysfunction.

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Síndrome do Seio Carotídeo Associada a Carcinoma Ex-Adenoma Pleomórfico: Qual o Papel da Estimulação Cardíaca Artificial?

Lani,

Elias Neto,

Silva

et al. 2024

Arq. Bras. Cardiol.

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Sequential Use of Aminophylline and Theophylline for Temporizing Neck Cancer-Induced Carotid Sinus Syncope

Cited by 4 publications

References 8 publications

Carotid Sinus Syndrome With Convulsive Syncope in a Patient With Head and Neck Cancer

Carotid Sinus Syndrome With Convulsive Syncope in a Patient With Head and Neck Cancer

Methylxanthine Derivatives in the Treatment of Sinus Node Dysfunction: A Systematic Review

Síndrome do Seio Carotídeo Associada a Carcinoma Ex-Adenoma Pleomórfico: Qual o Papel da Estimulação Cardíaca Artificial?

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