Key result
Administration of diphenylhydantoin and/or carbamazepine induced reversible sinoatrial block in three older patients, which resolved upon withdrawal of the medications.
Why the study?
Do diphenylhydantoin and carbamazepine induce sinoatrial block in aged patients?
Case Report (n=3)
No
Do diphenylhydantoin and carbamazepine induce sinoatrial block in aged patients?
Anticonvulsants such as diphenylhydantoin and carbamazepine can induce sinoatrial block in elderly patients, warranting careful electrocardiographic monitoring.
May induce reversible sinoatrial block in older patients; leaves open whether ECG monitoring is warranted.
Diphenylhydantoin (DPH) and Carbamazepine have been widely used as anticonvulsants and known to have antiarrhythmic properties. Previous reports have shown that arrhythmias such as sinus bradycardia and atrioventricular block can be induced by these agents. In this paper, sinoatrial block (SA block) induced by these agents which were used as anticonvulsants in 3 aged patients is reported. Thre patients, 2 women and 1 man, were over 60 years old. In 2 cases, administration of DPH for recurrent epileptic seizures was followed by SA block. After withdrawal of DPH, SA block disappeared, but resumption of DPH resulted in SA block again. In 1 of these 2 patients, overdrive suppression test revealed normal sinus node recovery time. In the third patient, in addition to DPH which was administered for epileptic seizures, Carbamazepine was given for shoulder pain, then SA block occurred. Withdrawal of these agents restored normal sinus rhythm and combined administration of these 2 agents again induced SA block. Autopsy revealed decreased conduction cells in the sinus node.
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Inoue et al. (1978) conducted a case report in Epileptic seizures and/or neuralgia treated with anticonvulsants (n=3). Diphenylhydantoin and/or Carbamazepine vs. Drug withdrawal was evaluated on Development of sinoatrial block. Administration of diphenylhydantoin and/or carbamazepine induced reversible sinoatrial block in three older patients, which resolved upon withdrawal of the medications.
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