Peginterferon-α
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Reactions 1480, p33 - 30 Nov 2013 S Peginterferon-α Sick sinus syndrome: case report A 45-year-old woman developed sick sinus syndrome while receiving peginterferon-α for the treatment of chronic hepatitis C [route not stated]. The woman was diagnosed with chronic genotype 1b hepatitis C, and began receiving peginterferon-α 80 µg/week and ribavirin. Six months later, she presented with general malaise. An ECG showed sino-atrial block, and her sinus cycle length was gradually reduced to 47/min. She also had TSH, free T4 and free T3 levels of 41.13 µU/mL, 0.59 ng/dL and 2.98 pg/mL, respectively. A diagnosis of interferon-related hypothyroidism. The woman was treated with levothyroxine sodium, and her TSH level normalised. Her symptoms did not improve, and were considered a psychosomatic side effect. After completing 48 weeks of peginterferon-α therapy, she presented with presyncope and sinus bradycardia. Tests revealed subclinical hypothyroidism, and ECG recordings showed sinus bradycardia and frequent sino-atrial block with concomitant presyncope. Her maximum, minimum and mean heart rate was 98, 31 and 55/min, and the total heart beats of the day was 74 327. She had RR intervals of more than 3 sec 511 times per day. Electrophysiology revealed 4.3 sec of the secondary pause following atrial overdrive pacing, resulting in a diagnosis of sick sinus syndrome. A permanent atrial pacemaker was implanted, and her symptoms resolved completely. Six months later, her heart rate was mostly dependent on the pacemaker. After decreasing the lower rate of the pacemaker to 45 bpm, 23% of her heart beats were produced by atrial pacing, suggesting irreversible sinus node dysfunction. Author comment: "In this case, we could not find any other cause of sinus node insufficiency except IFN [interferon] therapy, and the implantation of permanent cardiac pacemaker was necessary." Sakabe M, et al. Sick sinus syndrome induced by interferon and ribavirin therapy in a patient with chronic hepatitis C. Journal of Cardiology Cases 8: 173-175, No. 6, Dec 2013. Available from: URL: http://dx.doi.org/10.1016/j.jccase.2013.08.002 - Japan 803096096 1 Reactions 30 Nov 2013 No. 1480 0114-9954/13/1480-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Transcript of Peginterferon-α
Reactions 1480, p33 - 30 Nov 2013
SPeginterferon-αSick sinus syndrome: case report
A 45-year-old woman developed sick sinus syndrome whilereceiving peginterferon-α for the treatment of chronichepatitis C [route not stated].
The woman was diagnosed with chronic genotype 1bhepatitis C, and began receiving peginterferon-α 80 µg/weekand ribavirin. Six months later, she presented with generalmalaise. An ECG showed sino-atrial block, and her sinus cyclelength was gradually reduced to 47/min. She also had TSH,free T4 and free T3 levels of 41.13 µU/mL, 0.59 ng/dL and2.98 pg/mL, respectively. A diagnosis of interferon-relatedhypothyroidism.
The woman was treated with levothyroxine sodium, and herTSH level normalised. Her symptoms did not improve, andwere considered a psychosomatic side effect. After completing48 weeks of peginterferon-α therapy, she presented withpresyncope and sinus bradycardia. Tests revealed subclinicalhypothyroidism, and ECG recordings showed sinusbradycardia and frequent sino-atrial block with concomitantpresyncope. Her maximum, minimum and mean heart ratewas 98, 31 and 55/min, and the total heart beats of the day was74 327. She had RR intervals of more than 3 sec 511 times perday. Electrophysiology revealed 4.3 sec of the secondary pausefollowing atrial overdrive pacing, resulting in a diagnosis ofsick sinus syndrome. A permanent atrial pacemaker wasimplanted, and her symptoms resolved completely. Sixmonths later, her heart rate was mostly dependent on thepacemaker. After decreasing the lower rate of the pacemakerto 45 bpm, 23% of her heart beats were produced by atrialpacing, suggesting irreversible sinus node dysfunction.
Author comment: "In this case, we could not find anyother cause of sinus node insufficiency except IFN [interferon]therapy, and the implantation of permanent cardiacpacemaker was necessary."Sakabe M, et al. Sick sinus syndrome induced by interferon and ribavirin therapyin a patient with chronic hepatitis C. Journal of Cardiology Cases 8: 173-175, No.6, Dec 2013. Available from: URL: http://dx.doi.org/10.1016/j.jccase.2013.08.002 -Japan 803096096
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Reactions 30 Nov 2013 No. 14800114-9954/13/1480-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
