Lacosamide-Related Arrhythmias: A Systematic Analysis and Review of the Literature

Ruchi Yadav; Ezra Schrem; Vivek Yadav; Amog Jayarangaiah; Sushruth Das; Pramod Theetha Kariyanna

doi:10.7759/cureus.20736

Lacosamide-Related Arrhythmias: A Systematic Analysis and Review of the Literature

Cureus. 2021 Dec 27;13(12):e20736. doi: 10.7759/cureus.20736. eCollection 2021 Dec.

Authors

Ruchi Yadav¹, Ezra Schrem², Vivek Yadav³, Amog Jayarangaiah⁴, Sushruth Das⁵, Pramod Theetha Kariyanna⁶

Affiliations

¹ Internal Medicine, Brookdale University Hospital and Medical Center, New York City, USA.
² Internal Medicine, State University of New York Downstate Health Sciences University, New York City, USA.
³ Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York City, USA.
⁴ Internal Medicine, Marshfield Clinic Health System, Marshfield, USA.
⁵ Internal Medicine, Trinity School of Medicine, Kingstown, VCT.
⁶ Interventional Cardiology, Marshfield Clinic Medical Center, Eau Claire, USA.

Abstract

Lacosamide (LCM) is a new antiepileptic drug used as an adjunctive treatment for partial seizures with and without secondary generalization. One of the modes of action is the enhancement of slow inactivation of voltage-gated sodium channels. Experimental studies and clinical trials suggest that LCM acts upon both neurons and the heart and may increase the risk of cardiac arrhythmias. A systematic review was conducted to investigate characteristics of arrhythmias related to the use of LCM for the treatment of seizures. The search terms "lacosamide", "arrhythmias", "AV block", "atrial fibrillations/flutter", "cardiac conductions defects", "ventricular tachycardia", "ventricular fibrillation were used. Case reports and retrospective studies were gathered by searching Medline/PubMed, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane CENTRAL (Cochrane Central Register of Controlled Trials), and Web of Science databases. Seventeen articles were selected for review. Ventricular tachycardia was the most reported LCM related arrhythmia (29.4%), followed by new-onset atrial fibrillation (17.6%), complete heart block (17.6%), Mobitz type 1 Atrio-ventricular block (11.8%), sinus pauses (11.8%), pulseless electrical activity (5.9%) and widening QRS complex (5.9%). Further research and clinical trials are needed to explore the etiopathogenesis and causative relationship between the use of LCM and arrhythmias.

Keywords: : lacosamide; arrhythmias; atrial fibrillation; av block; echocardiography; electrocardiography; heart block; sinus pauses; ventricular tachycardia.

Publication types

Review