Berberine behind the thriller of marked symptomatic bradycardia

Area of Science:

• Cardiology
• Pharmacology
• Traditional Chinese Medicine

Background:

• Berberine is a compound used in Traditional Chinese Medicine for various conditions, including cardiovascular diseases.
• It is generally considered to have a good safety profile.
• Hypervagotonia, a state of increased parasympathetic nervous system activity, can predispose individuals to certain cardiovascular events.

Purpose of the Study:

• To report a case of adverse cardiovascular effects associated with berberine use.
• To investigate the potential proarrhythmic effects of berberine in individuals with a hypervagotonic state.
• To highlight the importance of considering patient-specific factors when prescribing berberine.

Main Methods:

• A case report of a 53-year-old male experiencing fatigue and dyspnea after initiating berberine for hypercholesterolemia.
• Electrocardiogram (ECG) and ergometric stress testing were performed.
• A 10-day berberine washout period was implemented, followed by repeat testing and Holter monitoring.

Main Results:

• Initial ECG revealed sinus bradycardia, atrioventricular block, and junctional rhythm.
• Stress testing showed reduced chronotropic competence and arrhythmias.
• After berberine cessation, symptoms resolved, stress test normalized, and Holter monitoring indicated a latent hypervagotonic state.

Conclusions:

• This case suggests berberine can induce bradycardic and antiarrhythmic effects that may become proarrhythmic in hypervagotonic individuals.
• The drug's use warrants caution in patients with a hypervagotonic state, even without conditions promoting drug accumulation.
• This highlights the need for personalized risk assessment when using berberine.