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Intermittent Atrioventricular Block following Fingolimod Initiation
E Gialafos1, S Gerakoulis1, A Grigoriou1
1Department of Neurology, Athens National and Kapodistrian University, "Aeginition" Hospital, 11528 Athens, Greece.
Case Reports in Neurological Medicine
|August 28, 2014
Summary
Fingolimod treatment in a multiple sclerosis patient was associated with a temporary atrioventricular block, potentially linked to autonomic nervous system dysfunction and the drug's effects.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Multiple sclerosis (MS) is a demyelinating disease affecting the central nervous system.
- Autonomic nervous system (ANS) dysfunction can occur in MS patients.
- Fingolimod is a disease-modifying therapy for MS.
Purpose of the Study:
- To report a case of atrioventricular block (AVB) in an MS patient treated with fingolimod.
- To investigate the potential link between fingolimod, ANS function, and cardiac arrhythmias in MS.
Main Methods:
- Case report of a 47-year-old female MS patient.
- Analysis of heart rate variability (HRV) using frequency domain analysis.
- Assessment of cardiac sympathetic function using modified Ewing tests.
Main Results:
- The patient developed symptomatic intermittent 2nd-degree AVB five hours after fingolimod administration, which resolved spontaneously.
- HRV analysis indicated increased parasympathetic activity and decreased sympathetic tone.
- Modified Ewing tests suggested impaired cardiac sympathetic function.
Conclusions:
- The observed atrioventricular block may be related to ANS dysfunction in MS, potentially exacerbated by fingolimod's parasympathetic effects.
- This case highlights the importance of monitoring cardiac function in MS patients during fingolimod treatment.
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