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Third degree atrioventricular block associated with treatment with rivastigmine transdermal patch
Fredrikke C Knudtzen1, Thomas B Christophersen
1Department of Internal Medicine, OUH Svendborg Hospital, Valdemarsgade 53, 5700 Svendborg, Denmark.
Journal of Geriatric Cardiology : JGC
|April 24, 2013
Summary
Rivastigmine, an acetylcholinesterase inhibitor, may cause severe heart rhythm issues like third-degree atrioventricular block. Physicians should monitor patients for warning signs such as dizziness and syncope.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Rivastigmine is an acetylcholinesterase inhibitor used for Alzheimer's disease and dementia with Parkinson's disease.
- Common side effects are gastrointestinal, with cardiovascular events rarely reported.
Observation:
- Two cases of third-degree atrioventricular block (AV block) in patients treated with rivastigmine are presented.
- One patient recovered sinus rhythm after rivastigmine discontinuation and AV block recurrence upon re-challenge.
- The other patient required a permanent pacemaker due to persistent AV block.
Findings:
- This report highlights a potential link between rivastigmine and severe bradycardia, specifically third-degree AV block.
- While bradycardia and syncope are known adverse events, the specific type and etiology are often unspecified.
Implications:
- Physicians should exercise vigilance for cardiac adverse events, including AV block, in patients treated with rivastigmine.
- Monitoring for warning signs like dizziness, syncope, and bradycardia is crucial for early detection and management.
- This finding contributes to understanding the cardiovascular safety profile of acetylcholinesterase inhibitors.
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