Left Bundle Branch Block: A Reversible Pernicious Effect of Lacosamide
Monil M Majmundar1, Tikal Kansara1, Palak Shah2
1Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA.
Cureus
|October 12, 2020
Summary
Lacosamide (LCM) therapy in an elderly male with epilepsy can cause reversible heart rhythm issues, including left bundle branch block (LBBB) and sinoatrial (SA) node dysfunction. Stopping LCM resolved these cardiac symptoms.
Area of Science:
- Cardiology
- Neurology
- Clinical Pharmacology
Background:
- Elderly patients with epilepsy often require polypharmacy, increasing the risk of adverse drug events.
- Lacosamide (LCM) is a commonly prescribed antiepileptic drug, but its cardiac effects require careful monitoring.
Observation:
- A 95-year-old male with focal epilepsy on lacosamide (LCM) and levetiracetam presented with transient ischemic attack (TIA)-like symptoms.
- Initial evaluation revealed new-onset left bundle branch block (LBBB), sinus pause, and atrioventricular (AV) block.
Findings:
- Discontinuation of lacosamide (LCM) led to the complete resolution of the electrocardiogram (ECG) abnormalities, including LBBB and SA/AV node dysfunction.
- This case highlights a potential iatrogenic cause of cardiac conduction abnormalities in elderly patients on LCM therapy.
Implications:
- Clinicians should consider LCM as a potential cause of reversible cardiac conduction abnormalities, particularly in elderly patients with pre-existing cardiac risk factors.
- This finding underscores the importance of thorough medication review and cardiac monitoring in elderly patients undergoing antiepileptic drug therapy.
- Further research is warranted to elucidate the electrophysiological mechanisms underlying LCM-induced cardiac conduction disturbances.
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