A note on pulse methylprednisolone and arrhythmias

A note on pulse methylprednisolone and arrhythmias

Glucocorticoids, particularly high doses, tend to cause arrhythmias like atrial flutter and fibrillation, irrespective of underlying pulmonary or cardiovascular disease. Sinus bradycardia has been reported, particularly with high "pulse" dose.  Although sudden death has also been attributed during pulse infusions of glucocorticoids, it's difficult to determine, as most of these patients have underlying severe comorbidities.

Cardiac monitoring is recommended, particularly when there is an underlying cardiac disease, diuretics on board, or associated electrolyte derangements are present.

#pharmacology

#cardiology

#pulmonary

References:

1. White KP, Driscoll MS, Rothe MJ, Grant-Kels JM. Severe adverse cardiovascular effects of pulse steroid therapy: is continuous cardiac monitoring necessary? J Am Acad Dermatol 1994; 30:768.

2. Christiansen CF, Christensen S, Mehnert F, et al. Glucocorticoid use and risk of atrial fibrillation or flutter: a population-based, case-control study. Arch Intern Med 2009; 169:1677.

3. Akikusa JD, Feldman BM, Gross GJ, et al. Sinus bradycardia after intravenous pulse methylprednisolone. Pediatrics 2007; 119:e778.