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Ticagrelor Induced Cheyne-Stokes Respiration and Asystolic Ventricular Standstill: A Case Report

Bektaş Murat1, Selda Murat2, Eylem Kivanc1

  • 1Eskisehir City Hospital.

Kardiologiia
|March 11, 2024
PubMed

Insights

Ticagrelor, a P2Y12 inhibitor, effectively reduces adverse events in acute coronary syndrome (ACS). However, rare cases show potential for serious bradyarrhythmias like asystolic ventricular standstill.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Ticagrelor is a reversible P2Y12 inhibitor used for acute coronary syndrome (ACS).
  • It demonstrates superior efficacy over clopidogrel in reducing major adverse events.
  • Commonly reported side effects include dyspnea and bradyarrhythmia.

Observation:

  • Previous studies indicated ticagrelor's bradyarrhythmic potential is transient and clinically insignificant.
  • This report details a rare case of ticagrelor-associated Cheyne-Stokes respiration and asystolic ventricular standstill.
  • The patient experienced cardiac arrest requiring resuscitation and temporary pacemaker insertion.

Findings:

  • Ticagrelor can be associated with severe bradyarrhythmic events, including asystolic ventricular standstill.
  • These events may necessitate immediate medical intervention, such as resuscitation and temporary pacing.
  • The findings challenge the notion that ticagrelor's bradyarrhythmic risks are always transient and clinically insignificant.

Implications:

  • Clinicians should maintain a high index of suspicion for severe bradyarrhythmia in ACS patients treated with ticagrelor.
  • Careful patient monitoring is crucial, especially during the acute initiation phase.
  • Further investigation into the mechanisms and risk factors for severe ticagrelor-associated bradyarrhythmias is warranted.

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