Oral diltiazem can induce sinoatrial block, highlighting the need to monitor for this conduction disturbance in addition to sinus node suppression and AV block.
Raises possibility of diltiazem-induced sinoatrial block; hypothesis-generating for expanded conduction monitoring in calcium channel blocker use.
A 58-year-old man with variant angina who had no history suggestive of sinus node dysfunction experienced palpitation with pulse deficit after 8 days of diltiazem treatment, 240 mg per day. Electrocardiogram (ECG) revealed frequent occurrence of sinoatrial block. After discontinuation of diltiazem, an ambulatory ECG demonstrated gradual reduction of the occurrence of sinoatrial block, and no recurrence 8 hours after the last dose of the drug. One should note that diltiazem induces not only sinus node suppression and atrioventricular conduction disturbance, but also sinoatrial block.
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Imamura et al. (1986) studied this question.
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