Aminophylline induced atrial fibrillation

Area of Science:

• Cardiology
• Pulmonology
• Pharmacology

Background:

• Atrial fibrillation (AF) is a common arrhythmia.
• Aminophylline is used to treat pulmonary diseases.
• Theophylline toxicity is a known risk factor for cardiac arrhythmias.

Purpose of the Study:

• To investigate the induction of atrial fibrillation by intravenous aminophylline in patients with pulmonary disease.
• To evaluate the efficacy of diltiazem versus digoxin in controlling the ventricular rate during aminophylline-induced AF.
• To understand the potential mechanisms of aminophylline-induced AF.

Main Methods:

• Case series of three patients with symptomatic pulmonary disease treated with intravenous aminophylline.
• Monitoring of serum theophylline concentrations.
• Assessment of cardiac rhythm and ventricular rate control using intravenous diltiazem and digoxin.
• Observation of AF resolution after aminophylline cessation.

Main Results:

• Three patients developed atrial fibrillation with rapid ventricular response during intravenous aminophylline therapy.
• Serum theophylline levels were therapeutic in two patients and toxic in one.
• AF resolved spontaneously 9-14 hours after aminophylline discontinuation.
• Intravenous diltiazem was more effective than digoxin in controlling the ventricular rate prior to sinus rhythm conversion.

Conclusions:

• Intravenous aminophylline can precipitate atrial fibrillation, irrespective of theophylline toxicity.
• Aminophylline-induced AF is reversible upon drug withdrawal.
• Diltiazem demonstrates superior efficacy over digoxin for ventricular rate control in this context.
• Potential mechanisms involve shortened atrial refractory periods and dispersed excitability recovery, promoting reentrant circuits.