Key result
Carvedilol triggers new-onset wide QRS complexes in a patient with permanent AF.
Case Report (n=1)
This case report presents an ECG challenge regarding wide QRS complexes in an elderly patient with permanent atrial fibrillation on rate control therapy.
Carvedilol may induce QRS widening during AF rate control; case report leaves open prevalence and mechanism.
ECG CHALLENGEAn asymptomatic 70-year-old man was referred for evaluation of recent-onset wide QRS beats, the frequency of which had gradually increased during the previous year.The patient's medical history was significant for hypertension and longstanding persistent atrial fibrillation (AF), which had lasted for at least 1 year.He had received telmisartan 40 mg/d, digoxin 0.1 mg/d, and warfarin 2 mg/d for 1 year.Carvedilol 2.5 mg/d was added to the regimen 2 months earlier to improve ventricular rate control.His physical examination was unremarkable.Laboratory data were unremarkable except for an elevated BNP (brain natriuretic peptide) level of 240 pg/mL (reference range <17.8 pg/mL).An echocardiogram showed no evidence of structural heart disease except for an enlarged left atrium (anteroposterior diameter, 55 mm).Twelve-lead ECGs before and after the initiation of rate control therapy are presented in Figure 1.
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Takasugi et al. (2020) conducted a case report in Permanent Atrial Fibrillation (n=1). Rate control therapy was evaluated. A 70-year-old man with permanent atrial fibrillation developed recent-onset wide QRS complexes after the addition of carvedilol for ventricular rate control.
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