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Atrial fibrillation and QT prolongation secondary to hypomagnesaemia: case report A 65-year-old man developed atrial fibrillation and QT prolongation secondary to hypomagnesaemia during treatment with indapamide and pantoprazole [routes, dosages and time to reactions onset not stated]. The man who was an active smoker and had a history of hypertension, lower myocardial infarction and old gastric cancer presented to an emergency room with palpitations. For hypertension, he was receiving atenolol, perindopril and indapamide, and for gastric ulcer, he was on long-term pantoprazole treatment. His other home medications were aspirin, prasugrel and atorvastatin. Upon presentation, an ECG showed atrial fibrillation (AF) with a rapid ventricular rate of 150 beats per minute, fine QRS with lower sequential Q waves and ventricular extrasystole (VES). Laboratory investigations showed haemoglobin 12.2 g/dL, albumin-corrected hypocalcaemia at 1.65mmol/L, severe hypomagnesaemia at 0.31 mmol/L. For hypomagnesaemia, the man treated with magnesium-sulfate and hypocalcaemia was treated with calcium gluconate. Following treatment, both were resolved, sinus rhythm returned at 60 per min with atrioventricular block type 1, normal QRS complexes and prolongation QT (QTc) to 520ms. Maintenance treatment with magnesium sulfate led to normalisation of QT interval within 48 hours. For hypomagnesaemia, his treatment with indapamide and pantoprazole was considered as a contributing factor. Hypocalcaemia was also considered as a complication of hypomagnesaemia and his underlying vitamin-D deficiency also played a role in the development of hypocalcaemia. In view of these findings, his treatment with pantoprazole was discontinued and he received supplementation therapy of calcium and vitamin D. As he had CHA2DS2Vasc score of 3 and his AF was reversible, he did not receive anticoagulant treatment. Noirclerc N, et al. Atrial fibrillation and QT prolongation due to proton pump inhibitor-induced hypomagnesemia. Annales de Cardiologie et d’Angeiologie : no pagination, 12 803501473 Aug 2020. Available from: URL: http://doi.org/10.1016/j.ancard.2020.07.016 [French; summarised from a translation]

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Reactions 19 Sep 2020 No. 1822