Disopyramide can induce myasthenia gravis crisis and subsequent severe cardiac complications due to its anti-cholinergic effects, warranting caution in patients with MG.
Supports caution with disopyramide in MG patients with AF; single case leaves open frequency of this interaction.
Class 1a anti-arrhythmic drugs are often used for the treatment of atrial fibrillation (AF), but it is not well known that myasthenia gravis (MG)-like symptoms can be generated by their anti-cholinergic effects. We had a patient with MG who developed symptomatic MG aggravation after AF treatment with disopyramide. Symptomatic MG aggravation was followed by Takotsubo-shaped cardiomyopathy, QT prolongation, and torsades de pointes. We suggest that the anti-cholinergic effects of disopyramide can induce MG crisis and should therefore be carefully considered when disopyramide is used to treat AF in patients with MG.
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Hirose et al. (2008) studied this question.
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