Atorvastatin-Associated Severe Bradyarrhythmia Following Multiorgan Dysfunction: A Case Report

Statins are the primary treatment for hypercholesterolemia and a cornerstone of atherosclerotic cardiovascular disease prevention. Although generally safe, serious adverse effects may occur in selected patients, particularly when statins are used at high doses or without medical supervision. We describe a 66-year-old man with hypertension and hyperlipidemia who developed syncope after self-adjusting atorvastatin from 20 mg daily to 80 mg daily for two weeks. On admission, electrocardiography showed sinus arrest with a ventricular escape rhythm, accompanied by acute hepatic and renal dysfunction, electrolyte abnormalities, coagulation abnormalities, and elevated inflammatory markers. Common reversible causes, including thyroid dysfunction, structural heart disease, acute myocarditis, Lyme disease, and the use of negative chronotropic drugs, were not supported by the clinical evaluation. After temporary pacing and supportive treatment, liver and kidney function, electrolytes, and coagulation function returned to normal; however, symptomatic sinus arrest persisted, and a permanent pacemaker was implanted. During follow-up, the electrocardiogram showed recovery of sinus rhythm. Pacemaker interrogation at 1 year showed a pacing burden of approximately 80% when the lower rate limit was programmed at 70 beats per minute; after the lower rate limit was reduced to 50 beats per minute, the pacing burden decreased to approximately 20% at the subsequent follow-up. This finding suggests partial recovery of intrinsic sinus rhythm but persistent or intermittent sinus node dysfunction. The case supports a cautious interpretation of possible atorvastatin-associated severe bradyarrhythmia mediated by multiorgan dysfunction rather than definitive direct statin-induced sinus node injury. Clinicians should carefully educate patients not to self-adjust statin doses and should monitor for serious adverse events when high-dose statin exposure is suspected.