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Varying AV Block Induced by Oxcarbazepine/Okskarbazepine Bagli Gelisen Degisken Tip AV Blok.

Dear Editor,

Oxcarbazepine is an epileptic drug with well-known adverse effects, which was first introduced in 1990 and is now used in many countries worldwide. Oxcarbazepine has been shown to have negative effects on the cardiac conduction system due to its mechanism of action, similar to that of carbamazepine.

A 68-year-old male who had had a diagnosis of epilepsy for 15 years and had been using oxcarbazepine twice a day for a year, was admitted to the emergency service with syncope. Electrocardiography (ECG) showed complete atrioventricular (AV) block (Figure 1A). No abnormality was found in his neurologic and physical examination. The patient was cooperative and oriented. Blood pressure was 110/70 mmHg and heart rate was 40/min. Laboratory findings in blood were normal but the serum concentration of oxcarbazepine could not be measured in the emergency service. The patient was hospitalized in the coronary intensive care unit and a temporary pacemaker was inserted. Echocardiographic findings were normal. Follow-up ECGs showed varying AV blocks (Figure 1A, 1B). The patient was referred to the department of neurology because of oxcarbazepine's effects on the cardiac conduction system. Levetiracetam was initiated and oxcarbazepine was ceased. Rhythm Holter showed 1 (st) degree, 2 (nd) degree (Mobitz type 1 and 2), and 3 (rd) degree AV blocks (Figure 2A, 2B, 2C, 2D). Four days after the drug change, the cardiac rhythm of the patient returned to normal. The pacemaker was removed and the patient was discharged.

Oxcarbazepine is an antiepileptic drug that is also used in the treatment of neuropathic pain and bipolar affective disorder (1). Its chemical structure is similar to carbamazepine and both have similar mechanisms of action (2). Oxcarbazepine shows an antiepileptic effect as carbamazepine does by blocking voltage gated Na+ channels and preventing neuronal membrane depolarization and spread of pathologic neuronal discharge (3). Both drugs with may cause blocks in the cardiac conduction system and previously, Karasu and Baktir (4) reported a patient using oxcarbazepine who developed varying AV blocks. Our patient also had complete varying AV blocks. In older patients, in the approach to cardiac conduction system disorders, it is important to question the additional diseases of patients and especially the drugs they are using and to review the rare adverse effects.

Ethics

Informed Consent: Consent form was filled out by all participants.

Peer-review: Internally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: E.E.S., O.S., Concept: O.O., Design: M.N.A., I.T.O., Data Collection or Processing: A.C., Analysis or Interpretation: B.O., Literature Search: E.E.S., Writing: E.E.S.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.

References

(1.) Johannessen Landmark C. Antiepileptic drugs in non-epilepsy disorders: relations between mechanisms of action and clinical efficacy. CNS Drugs 2008;22:27-47.

(2.) McLean MJ, Schmutz M, Wamil AW, Olpe HR, Portet C, Feldmann KF. Oxcarbazepine: mechanisms of action. Epilepsia 1994;35(Suppl 3):5-9.

(3.) Tecoma ES. Oxcarbazepine. Epilepsia 1999;40(Suppl 5):37-46.

(4.) Karasu E, Baktir AO. Three Types of Atrioventricular Block Induced by Oxcarbazepine in a Young Adult. Bulletin of Clinical Psychopharmacology 2013;23:84-88.

[iD] Ozcan Orscelik, [iD] Bugra Ozkan, [iD] Ertan Emre Sahin, [iD] Ozan Sakarya, [iD] Ahmet Celik, [iD] Mehmet Necdet Akkus, [iD] Ismail Turkay Ozcan

Mersin Universitesi Tip Fakultesi, Kardiyoloji Anabilim Dali, Mersin, Turkiye

Keywords: Antiepileptic, oxcarbamazepine, AV block

Anahtar Kelimeler: Antiepileptik, okskarbazepin, AV blok

Address for Correspondence/Yazisma Adresi: Ertan Emre Sahin MD, Mersin University Faculty of Medicine, Department of Cardiology, Mersin, Turkey

Phone: +90 538 541 88 78 E-mail: drertansahin@gmail.com ORCID ID: orcid.org/0000-0003-2688-1910

Received/Gelis Tarihi: 07.08.2017 Accepted/Kabul Tarihi: 26.01.2018

DOI:10.4274/tnd.75735
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Author:Orscelik, Ozcan; Ozkan, Bugra; Sahin, Ertan Emre; Sakarya, Ozan; Celik, Ahmet; Akkus, Mehmet Necdet;
Publication:Turkish Journal of Neurology
Date:Sep 1, 2018
Words:626
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