A left lateral accessory pathway unmasked by rivastigmine
Charles Guenancia1, Marie Fichot2, Fabien Garnier2
1Cardiology Department, University Hospital, Dijon, France; LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France.
Rivastigmine, a cholinesterase inhibitor, unmasked a previously undiagnosed left lateral accessory pathway in a patient. This suggests cholinesterase inhibitors may alter cardiac conduction pathways.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Cholinesterase inhibitors are used to treat cognitive decline.
- Their effects on cardiac electrophysiology are not fully understood.
Observation:
- A 75-year-old woman on rivastigmine showed new ECG findings.
- Baseline ECGs were normal prior to rivastigmine initiation.
Findings:
- Rivastigmine unmasked a left lateral accessory pathway.
- The PR interval shortened, contradicting increased vagal tone as the cause.
Implications:
- Cholinesterase inhibitors might increase conduction velocity in accessory pathways or atria.
- Further research is needed to understand these electrophysiological effects.
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