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Bradyarrhythmias secondary to topical levobunolol hydrochloride solution.

Lin L, Wang Y, Chen Y, Liu M - Clin Interv Aging (2014)

Bottom Line: The levobunolol hydrochloride solution was discontinued and the bradycardia resolved.Levobunolol hydrochloride solution is an effective therapy for ocular hypertension, probably by reducing aqueous fluid production.However, it can induce cardiac side effects such as bradyarrhythmia and should be used with caution in elderly patients or patients with cardiac disease.

View Article: PubMed Central - PubMed

Affiliation: Geriatric Department, Peking University First Hospital, Beijing, People's Republic of China.

ABSTRACT
An 88-year-old man was admitted with fatigue, dizziness, and heart palpitations. Both the electrocardiogram and Holter confirmed the existence of sinus bradycardia and sinus arrest. One hour prior to the onset of symptoms, he received levobunolol hydrochloride solution topically. The levobunolol hydrochloride solution was discontinued and the bradycardia resolved. He was diagnosed as having intermittent sinus bradycardia and sinus arrest, induced by topical β-blocker therapy. Levobunolol hydrochloride solution is an effective therapy for ocular hypertension, probably by reducing aqueous fluid production. However, it can induce cardiac side effects such as bradyarrhythmia and should be used with caution in elderly patients or patients with cardiac disease.

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Holter results.Notes: Holter recorded the minimum heart rate at 25 bpm with a long R–R interval of 3.5 seconds at 9:59 am, about 2 hours after the instillation of levobunolol hydrochloride solution (A). After 48 hours of withdrawal of levobunolol, Holter showed no obvious sinus arrest and the minimum heart rate was 37 bpm (B).Abbreviation: bpm, beats per minute.
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f3-cia-9-1741: Holter results.Notes: Holter recorded the minimum heart rate at 25 bpm with a long R–R interval of 3.5 seconds at 9:59 am, about 2 hours after the instillation of levobunolol hydrochloride solution (A). After 48 hours of withdrawal of levobunolol, Holter showed no obvious sinus arrest and the minimum heart rate was 37 bpm (B).Abbreviation: bpm, beats per minute.

Mentions: An 88-year-old man was admitted to the hospital with abdominal pain. His past history included coronary heart disease for which he underwent percutaneous coronary interventional treatment. He complained of fatigue, dizziness, and heart palpitations, and an electrocardiogram (ECG) demonstrated sinus bradycardia at a rate of 39 bpm (the day of hospitalization; Figures 1A and 2A). Holter was taken the second day after being admitted to our hospital, which showed sinus bradycardia, atrioventricular block (first degree), and sinus arrest (Figure 1B). The average heart rate was 54 bpm and the range of heart rate varied from 25 bpm (Figure 3A) to 79 bpm. There were 265 episodes of sinus arrest lasting longer than 2 seconds and six arrests longer than 3 seconds (Figure 3A). Serum electrolyte test, complete blood count, thyroid function test, and cardiac marker panel were all within normal limits. After careful review of his history and medication list, the only medication that may be associated with bradycardia was levobunolol hydrochloride solution, which he had been using, one to two drops to each eye, two to three times per day for several years. The lowest heart rate was reached (25 bpm), approximately two hours after instillation of the eyedrops (Figure 1C). Because of the clear relationship between onset of symptomatic bradycardia and the instillation of eyedrops, levobunolol hydrochloride solution was discontinued and replaced with latanoprost eyedrops. After 48 hours, the bradycardia and associated symptoms disappeared. Heart rhythm was re-evaluated after cessation of levobunolol hydrochloride solution by ECG and Holter. ECG showed normal heart rhythm (Figure 2B) and Holter showed sinus rhythm, with an average heart rate of 67 bpm (Figure 3B). The range of heart rate varied from 37 bpm to 117 bpm. The number of sinus arrests lasting longer than 2 seconds decreased to eight. Ten days later, the heart rate range recovered to 53 bpm to 100 bpm with an average heart rate of 73 bpm, and the sinus arrest disappeared as shown by Holter.


Bradyarrhythmias secondary to topical levobunolol hydrochloride solution.

Lin L, Wang Y, Chen Y, Liu M - Clin Interv Aging (2014)

Holter results.Notes: Holter recorded the minimum heart rate at 25 bpm with a long R–R interval of 3.5 seconds at 9:59 am, about 2 hours after the instillation of levobunolol hydrochloride solution (A). After 48 hours of withdrawal of levobunolol, Holter showed no obvious sinus arrest and the minimum heart rate was 37 bpm (B).Abbreviation: bpm, beats per minute.
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f3-cia-9-1741: Holter results.Notes: Holter recorded the minimum heart rate at 25 bpm with a long R–R interval of 3.5 seconds at 9:59 am, about 2 hours after the instillation of levobunolol hydrochloride solution (A). After 48 hours of withdrawal of levobunolol, Holter showed no obvious sinus arrest and the minimum heart rate was 37 bpm (B).Abbreviation: bpm, beats per minute.
Mentions: An 88-year-old man was admitted to the hospital with abdominal pain. His past history included coronary heart disease for which he underwent percutaneous coronary interventional treatment. He complained of fatigue, dizziness, and heart palpitations, and an electrocardiogram (ECG) demonstrated sinus bradycardia at a rate of 39 bpm (the day of hospitalization; Figures 1A and 2A). Holter was taken the second day after being admitted to our hospital, which showed sinus bradycardia, atrioventricular block (first degree), and sinus arrest (Figure 1B). The average heart rate was 54 bpm and the range of heart rate varied from 25 bpm (Figure 3A) to 79 bpm. There were 265 episodes of sinus arrest lasting longer than 2 seconds and six arrests longer than 3 seconds (Figure 3A). Serum electrolyte test, complete blood count, thyroid function test, and cardiac marker panel were all within normal limits. After careful review of his history and medication list, the only medication that may be associated with bradycardia was levobunolol hydrochloride solution, which he had been using, one to two drops to each eye, two to three times per day for several years. The lowest heart rate was reached (25 bpm), approximately two hours after instillation of the eyedrops (Figure 1C). Because of the clear relationship between onset of symptomatic bradycardia and the instillation of eyedrops, levobunolol hydrochloride solution was discontinued and replaced with latanoprost eyedrops. After 48 hours, the bradycardia and associated symptoms disappeared. Heart rhythm was re-evaluated after cessation of levobunolol hydrochloride solution by ECG and Holter. ECG showed normal heart rhythm (Figure 2B) and Holter showed sinus rhythm, with an average heart rate of 67 bpm (Figure 3B). The range of heart rate varied from 37 bpm to 117 bpm. The number of sinus arrests lasting longer than 2 seconds decreased to eight. Ten days later, the heart rate range recovered to 53 bpm to 100 bpm with an average heart rate of 73 bpm, and the sinus arrest disappeared as shown by Holter.

Bottom Line: The levobunolol hydrochloride solution was discontinued and the bradycardia resolved.Levobunolol hydrochloride solution is an effective therapy for ocular hypertension, probably by reducing aqueous fluid production.However, it can induce cardiac side effects such as bradyarrhythmia and should be used with caution in elderly patients or patients with cardiac disease.

View Article: PubMed Central - PubMed

Affiliation: Geriatric Department, Peking University First Hospital, Beijing, People's Republic of China.

ABSTRACT
An 88-year-old man was admitted with fatigue, dizziness, and heart palpitations. Both the electrocardiogram and Holter confirmed the existence of sinus bradycardia and sinus arrest. One hour prior to the onset of symptoms, he received levobunolol hydrochloride solution topically. The levobunolol hydrochloride solution was discontinued and the bradycardia resolved. He was diagnosed as having intermittent sinus bradycardia and sinus arrest, induced by topical β-blocker therapy. Levobunolol hydrochloride solution is an effective therapy for ocular hypertension, probably by reducing aqueous fluid production. However, it can induce cardiac side effects such as bradyarrhythmia and should be used with caution in elderly patients or patients with cardiac disease.

Show MeSH
Related in: MedlinePlus