Ticagrelor therapy and atrioventricular block: Do we need to worry?

Area of Science:

• Cardiology
• Pharmacology

Background:

• Ticagrelor is a P2Y12 antagonist for acute coronary syndromes (ACS).
• While generally well-tolerated, ticagrelor is associated with bradyarrhythmias.
• Current labeling does not highlight risks of severe atrioventricular (AV) block.

Observation:

• A PLATO substudy noted increased sinus bradycardia and arrest with ticagrelor versus clopidogrel.
• This effect was usually transient and asymptomatic.
• Recent reports describe severe, life-threatening AV block requiring intervention.

Findings:

• This paper reviews seven cases of severe AV block post-ticagrelor therapy.
• Analysis suggests ticagrelor is rarely associated with life-threatening AV block.

Implications:

• Caution and monitoring are necessary for patients with compromised conduction systems or on AV blocking agents.
• Further research with long-term rhythm monitoring is needed to assess risks in high-risk patients.