Clinicoepidemiological Profile of Ciguatera Cardiotoxicity: A Systematic Review
Clarke Morihara1, Thanaboon Yinadsawaphan1, Christian John Capirig1
1Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii.
Insights
Ciguatera poisoning can cause unrecognized heart problems, primarily hypotension and bradycardia. Early recognition and intervention lead to benign outcomes for patients with ciguatera cardiotoxicity.
Area of Science:
- Toxicology
- Cardiology
- Public Health
Background:
- Ciguatera poisoning, a significant marine neurotoxin illness, is known for gastrointestinal and neurologic symptoms.
- Cardiotoxicity associated with ciguatera poisoning remains largely unrecognized by clinicians.
- This systematic review aims to elucidate the clinical characteristics of ciguatera-induced cardiotoxicity.
Approach:
- Conducted a systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
- Searched MEDLINE and EMBASE databases for peer-reviewed articles on ciguatera and cardiotoxicity up to January 2024.
- Included 20 articles comprising 148 patient cases.
Key Points:
- The median patient age was 54 years, with a male predominance (62.2%).
- Hypotension (75.0%) and bradycardia (67.6%) were the most frequent cardiac manifestations.
- Sinus bradycardia (35.9%) and atrioventricular blocks (15.4%) were common electrocardiogram findings.
- Most cases were reported from the Western Pacific Region (68.5%).
Conclusions:
- Ciguatera cardiotoxicity presents with distinct clinical and electrocardiographic features, predominantly hypotension and bradycardia.
- While underrecognized, prompt identification and symptomatic treatment can lead to favorable patient outcomes.
- Increased clinician awareness is essential for managing ciguatera poisoning and preventing severe cardiac complications.
Abstract:
Patients with ciguatera poisoning commonly present with gastrointestinal and neurologic symptoms, but its cardiotoxicity has been largely unrecognized. This systematic review is the first to summarize the evidence regarding clinical characteristics of cardiotoxicity from ciguatera poisoning to provide the illness script and pertinent knowledge for clinicians. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "ciguatera" and "cardiotoxicity" from their inception to January 2024. We included 20 articles, including 148 cases, in this systematic review. Among the included cases, the median age was 54 years with male predominance (62.2%). Based on the WHO designation, 68.5% were reported from the Western Pacific Region. Common symptoms included hypotension (75.0%) and bradycardia (67.6%), and chest pain or syncope were less commonly reported (2.7% and 1.4%, respectively). Sinus bradycardia was the most common electrocardiogram abnormality (35.9%), followed by atrioventricular blocks (15.4%). Symptomatic treatments such as atropine, dopamine, and epinephrine were commonly used, and only 4.1% required intensive care unit admission. None expired due to cardiotoxicity from ciguatera. This review summarizes the current evidence and the characteristics of cardiotoxicity from ciguatera. Although ciguatera cardiotoxicity is currently underrecognized, increased awareness of the condition in clinicians is crucial because the clinical outcomes of the patients could be benign as long as it is identified and intervened early.
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