Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
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Case Report

Volume 8, Number 3, June 2017, pages 123-127

Ticagrelor-Associated Conduction Disorder: A Case Report and Review of the Literature

Figures

Figure 1.
Figure 1. Baseline ECG showing a sinus rhythm along with ST depression on inferolateral derivations without evidence of conduction disorder.
Figure 2.
Figure 2. Coronary angiography showing distal occlusion of the ndLCx artery (a, white arrow), and full patency of the relevant thrombotic lesion after successful percutaneous coronary intervention (b). ndLCx: non-dominant left circumflex.
Figure 3.
Figure 3. ECGs showing a sinus rhythm with prolonged PR interval of 260 ms approximately 10 h after taking ticagrelor loading dose (a), complete atrioventricular block on the next (second) day (b), mild first degree atrioventricular block at 220 ms after the cessation of ticagrelor on the third day (c), and normal sinus rhythm without evidence of conduction disorder on the fourth day (d).

Table

Table 1. Characteritics of Patients in the Cases of Ticagrelor-Induced Cardiac Arrhythmia Reported in the Literature [5-13]
 
AuthorAge/sexTime from ticagrelor intake to onset of cardiac arrhythmia or related symptomsSymptomsECGThe underlying diseaseTreatmentPre-existing conduction disease and/or AV blocking agent
ACS: acute coronary syndrome; AVB: atrioventricular block; ECG: electrocardiography; LAD: left anterior descending artery; LBBB: left bundle branch block; LCx: left circumflex artery; M: male; NA: not applicable; NSTEMI: non-ST-elevation myocardial infarction; RBBB: right bundle branch block; RCA: right coronary artery; STEMI: ST-elevation myocardial infarction.
Nicol et al [5]39/M1 hNoVentricular pauseSTEMI - LADFollow-upNo/atenolol
Goldberg et al [6]52/M4 hSyncopeShort episodes of AVB, and ventricular pauseNSTEMI - LMCA to LCxHemodynamic support and temporary pacemakerRBBB/bisoprolol
Goldberg et al [7]71/M3 hSyncopeAVB, deep bradicardia, ventricular pauseSTEMI - LADHemodynamic support and temporary pacemakerLBBB/bisoprolol
Baker et al [8]56/M1 hLightheadedness, diaphoresis and nausea1 h later: borderline first-degree AVB,
3 h later: sinus bradycardia followed by sinus arrest, and complete AVB		NSTEMI - LADTemporary pacemakerNo/no
Ozturk et al [9]62/M7 hNoMobitz tip-2 AVBSTEMI - RCAFollow-upFirst degree AVB/metoprolol
Unlu et al [10]NA/NA4 hNAMobitz tip-2 AVBACS - LCxPermanent pacemakerFirst-degree AVB/metoprolol
Sharma et al [11]55/M2 monthsFatigue and intermittent dizzinessMobitz tip-2 AVBACS - LCxFollow-upModerately first-degree AVB - RBBB/metoprolol
Zhang et al [12]74/M6 hPalpitationAtrial fibrillationACS - LADFollow-upRBBB/bisoprolol
Serafino et al [13]51/M2 days after ticagrelor; few hours after ivabradineNASevere sinus bradicardia and arrestSTEMI - LADHemodynamic support and follow-upNA/carvediolol and ivabradine