Ticagrelor Associated Heart Block: The Need for Close and Continued Monitoring

Area of Science:

• Cardiology
• Pharmacology

Background:

• Ticagrelor is a P2Y12 inhibitor used to prevent thrombotic events in acute coronary syndrome (ACS).
• The PLATO trial noted ventricular pauses with ticagrelor, generally considered asymptomatic.

Observation:

• A patient on ticagrelor developed symptomatic second-degree type II heart block.
• Symptoms included severe dizziness and diaphoresis.

Findings:

• Ticagrelor was identified as the likely cause of the heart block.
• Discontinuation of ticagrelor led to the resolution of the heart block and associated symptoms.

Implications:

• This case highlights a potential, serious adverse cardiac event associated with ticagrelor.
• Clinicians should consider ticagrelor-induced heart block in patients presenting with relevant symptoms.