Side effects of ticagrelor: Sinus node dysfunction with ventricular pause

Nicol, Martin; Deblaise, Julien; Choussat, Rémi; Dubourg, Olivier; Mansencal, Nicolas

doi:10.1016/j.ijcard.2015.04.198

Cited by 12 publications

(8 citation statements)

References 9 publications

(10 reference statements)

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“…Apart from the normal course of ACS, there is a case report indicating that ticagrelor, which increases plasma concentration of adenosine, may cause AF [18]. PLATO trial and some case reports have shown that ticagrelor causes bradyarrhythmias, such as atrioventricular block and sinus node pause [3,[25][26][27]. The most probable mechanism for these bradycardic events appears to be increasing plasma concentration of adenosine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Algül¹,

Sunman²,

Dural³

et al. 2019

Turk J Med Sci

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Background/aim: Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that specifically increases the plasma level of adenosine, which is likely to cause atrial fibrillation (AF). Therefore, in this study we aimed to investigate the electrocardiographic and echocardiographic predictors of AF development after P2Y12 receptor antagonists in ACS patients. Materials and methods:This cross-sectional study included 831 patients with ACS (486 [58.5%] with ST elevated myocardial infarction [STEMI] and 345 [41.5%] with non-ST elevated myocardial infarction [NSTEMI]). Patients were divided into ticagrelor (n = 410) and clopidogrel (n = 421) groups. P wave properties including P wave dispersion and atrial electromechanical conduction properties were measured as AF predictors with surface ECG and tissue Doppler imaging.Results: Baseline characteristics such as age, sex, heart rate, blood pressure, and laboratory parameters were almost the same in the ticagrelor and clopidogrel groups. The statistical analysis showed no significant difference in P wave dispersion (PWD) between ticagrelor and clopidogrel groups (40.98 ± 12 ms versus 40.06 ± 12 ms, P = 0.304). Subgroups analysis according to ACS types also showed no significant difference in PWD (NSTEMI: 41.16 ± 13.8 ms versus 40.76 ± 13.55 ms, P = 0.799; STEMI: 40.9 ± 12.62 ms versus 39.19 ± 11.18 ms, P = 0.132). In addition, we did not find significant difference in atrial electromechanical delay (EMD) with tissue Doppler imaging (interatrial EMD 24.11 ± 3.06 ms versus 24.46 ± 3.23 ms, P = 0.279). Conclusion:In conclusion, we did not find any difference in detailed electrocardiographic and echocardiographic parameters as AF predictors between ticagrelor and clopidogrel groups in patients with ACS.

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Section: Discussionmentioning

confidence: 99%

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Algül¹,

Sunman²,

Dural³

et al. 2019

Turk J Med Sci

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“…Recently, there have been several reports showing that ticagrelor may be associated with conduction abnormalities. After performing a detailed PubMed search, we were able to find only nine cases on topic of ticagrelor-related conduction abnormalities [5-13]. Table 1 [5-13] shows characteristics of the patients in the formerly reported those cases.…”

Section: Discussionmentioning

confidence: 99%

“…After performing a detailed PubMed search, we were able to find only nine cases on topic of ticagrelor-related conduction abnormalities [5-13]. Table 1 [5-13] shows characteristics of the patients in the formerly reported those cases. The mean age of patients was 57.5 years, with 100% being male, except for one case, whose age and gender were not mentioned [10].…”

Section: Discussionmentioning

confidence: 99%

“…The mean age of patients was 57.5 years, with 100% being male, except for one case, whose age and gender were not mentioned [10]. All patients developed various degrees of AVB and sinusal arrest or ventricular pause [5-12], except for one case who developed atrial fibrillation (AF) [13]. Of nine patients, six had pre-existing AV conduction disorder, eight were on AV blocking agents.…”

Section: Discussionmentioning

confidence: 99%

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Ticagrelor-Associated Conduction Disorder: A Case Report and Review of the Literature

Yurtdaş

Özdemir²

2017

Cardiol Res

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A 47-year-old female presented to emergency clinic due to non-ST-elevation myocardial infarction (NSTEMI). After receiving acetylsalicylic acid, a loading dose of ticagrelor 180 mg and intravenous unfractionated heparin, she underwent successful placement of drug eluting stent on the distal part of non-dominant left circumflex artery. The patient had no pre-existing atrioventricular (AV) block and did not use AV blocking agent. Approximately 10 h after taking a loading dose of ticagrelor, baseline normal rhythm degenerated to the first and then complete AV block, with mild dizziness. Following cessation of ticagrelor, cardiac rhythm returned to normal level within 2 days. The close monitoring of patients after starting ticagrelor is imperative, so ticagrelor may result in advanced conduction disorders. Here, we report a patient who developed various types of AV block associated with the ticagrelor taken during successful percutaneous coronary intervention for NSTEMI. We also reviewed the literature on the association between ticagrelor use and conduction abnormalities.

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“…80,81 The antiplatelet agent ticagrelor has been implicated in sinus node dysfunction and ventricular pauses, potentially via increased production of adenosine. 82…”

Section: Sick Sinus Syndromementioning

confidence: 99%

Unmasking Adenosine: The Purinergic Signalling Molecule Critical to Arrhythmia Pathophysiology and Management

Matthews

Grace

2020

Arrhythm Electrophysiol Rev

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Adenosine was identified in 1929 and immediately recognised as having a potential role in therapy for arrhythmia because of its negative chronotropic and dromotropic effects. Adenosine entered mainstream use in the 1980s as a highly effective agent for the termination of supraventricular tachycardia (SVT) involving the atrioventricular node, as well as for its ability to unmask the underlying rhythm in other SVTs. Adenosine has subsequently been found to have applications in interventional electrophysiology. While considered a safe agent because of its short half-life, adenosine may provoke arrhythmias in the form of AF, bradyarrhythmia and ventricular tachyarrhythmia. Adenosine is also associated with bronchospasm, although this may reflect irritant-induced dyspnoea rather than true obstruction. Adenosine is linked to numerous pathologies relevant to arrhythmia predisposition, including heart failure, obesity, ischaemia and the ageing process itself. This article examines 90 years of experience with adenosine in the light of new European Society of Cardiology guidelines for the management of SVT.

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Side effects of ticagrelor: Sinus node dysfunction with ventricular pause

Cited by 12 publications

References 9 publications

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Ticagrelor-Associated Conduction Disorder: A Case Report and Review of the Literature

Unmasking Adenosine: The Purinergic Signalling Molecule Critical to Arrhythmia Pathophysiology and Management

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