Bisoprolol
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Atypical type I second degree atrioventricular block: case report A 59-year-old man developed atypical type I second degree atrioventricular (AV) block during treatment with bisoprolol for postural orthostatic tachycardia syndrome (POTS). The man had recurrent episodes of palpitations and documented narrow QRS complex tachycardia. He was diagnosed with a slow-fast AV nodal reentry tachycardia (AVNRT). Two RF pulses were delivered. He was administered bisoprolol 10 mg/day. Postablation there was no change in his condition. He was admitted to telemetry ward. His symptoms were thought to be triggered by orthostatism. ECG showed sinus tachycardia in association with a 2nd degree AV block, which was expected as his anterograde Wenckebach in the electrophysiology lab was of 460 msec. Afterwards, heart rate (HR) slowed down and II degree AV block disappeared. The symptoms were reliably reproduced by standing up from a reclining position and relieved by lying back down. Thus, he was diagnosed with POTS and was restarted on bisoprolol 5 mg/day [the dose was half of the original dose; route not stated]. There was no evidence of recurrence of further AV conduction abnormalities. ECG was recorded both in a reclining position and standing up. The results showed no evidence of normal sinus rhythm as well as no signs of AV conduction impairment. Therefore, he was discharged home. Five days following discharge, he presented at the emergency room complaining of irregular beats, fatigue and dyspnoea. ECG showed atypical type I second degree AV block with an average HR of 43 /minute [duration of treatment to reaction onset not stated]. The man’s treatment with bisoprolol was immediately discontinued and he was admitted for electrocardiographic monitoring. An echocardiogram excluded pericardial effusion, valvulopathies or change in left ventricular systolic function. In the 48 hours following the re-admission, there was no change in AV conduction. Therefore, a systemic corticosteroid treatment was initiated with methylprednisolone. Four days following initiation of methylprednisolone, ECG results progressively normalised. Within a week from discharge, corticosteroids treatment was tapered off and stopped. Thirty days following the ablation, a 24-hour Holter ECG showed evidence of constant sinus rhythm with normal AV conduction and normal chronotropic competence. The maximum HR recorded on the Holter ECG was 133 bpm with 1:1 conduction between the atria to the ventricles. Capulzini L, et al. Delayed reversible atypical type I second degree atrio-ventricular block in a patient undergone slow pathway radiofrequency ablation: A case report and a 803500593 short review of the literature. IJC Heart and Vasculature 30: 100611, Oct 2020. Available from: URL: http://doi.org/10.1016/j.ijcha.2020.100611
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Reactions 12 Sep 2020 No. 1821
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