Mefloquine can cause dangerous 1:1 AV conduction in patients with atrial flutter, highlighting the need for caution in patients with underlying heart disease or a history of palpitations.
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Suggests mefloquine arrhythmogenicity in atrial flutter; single case is hypothesis-generating and should not yet change practice.
Antimalarial drugs are well known for their cardiovascular toxicity. Quinine, the most famous antimalarial agent, mostly causes bradycardia. Quinidine, its dextrorotatory isomer, may cause 1:1 atrioventricular (AV) conduction during atrial flutter. The newly developed drug mefloquine was reported to have fewer cardiac side effects. We describe a 63-year-old male patient with atrial flutter in whom mefloquine use was associated with 1:1 AV conduction, and who then responded to therapy with digoxin and sotalol. The patient had a history of palpitations. This case report emphasizes that mefloquine should be used with caution in patients with a history of palpitations or underlying heart disease.
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Fonteyne et al. (1996) studied this question.
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