CARBAMAZEPINE-INDUCED ATRIOVENTRICULAR HEART BLOCK: MECHANISMS AND MANAGEMENT

Аннотация

INTRODUCTION block, although relatively low, has gained Carbamazepine, an anticonvulsant and mood- recognition in recent years, prompting further stabilizing medication, is widely used in the investigation into its underlying mechanisms and treatment of epilepsy, trigeminal neuralgia, and clinical implications. Proposed mechanisms for this bipolar disorder. While generally considered safe phenomenon include direct effects on cardiac and effective, carbamazepine is associated with a conduction pathways, alterations in electrolyte range of adverse effects, one of the more serious levels, particularly sodium and potassium, and being atrioventricular (AV) heart block. This interactions with other pharmacological agents. cardiac complication can lead to significant These factors may compromise the heart’s morbidity, characterized by a disruption in the electrical system, leading to varying degrees of AV normal electrical conduction pathways of the heart, block, which can manifest as bradycardia, resulting in impaired ventricular filling and dizziness, syncope, or even cardiac arrest in severe potentially life-threatening arrhythmias. cases. The incidence of carbamazepine-induced AV heart The clinical presentation of AV heart block can vary https://www.theamericanjournals.com/index.php/tajmspr 1 THE USA JOURNALS THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH (ISSN – 2689-1026) VOLUME 06 ISSUE11 widely, often depending on the degree of using multiple electronic databases, including blockage—ranging from first-degree AV block, PubMed, Google Scholar, and Scopus. The search which may be asymptomatic, to complete heart strategy included keywords such as block, requiring immediate medical attention. “carbamazepine,” “atrioventricular heart block,” Given the potential for severe outcomes, early “cardiac conduction,” “adverse effects,” and recognition and appropriate management of this “management.” Articles published within the last adverse effect are crucial for ensuring patient two decades were prioritized to ensure the safety. inclusion of contemporary research findings and clinical perspectives. Studies selected for review This review aims to elucidate the mechanisms by included clinical trials, case reports, and systematic which carbamazepine can induce AV heart block reviews that focused on the relationship between and to provide guidance on management carbamazepine use and the development of AV strategies. By enhancing awareness of this rare yet heart block, as well as the proposed mechanisms significant complication, healthcare providers can and management strategies. The exclusion criteria better monitor patients on carbamazepine therapy encompassed studies that did not provide and implement timely interventions to mitigate sufficient detail on cardiac effects or lacked peer- risks. Ultimately, understanding the interplay reviewed validation. between carbamazepine and cardiac conduction pathways can contribute to improved patient Data Extraction and Analysis outcomes and more effective management of this Following the selection of relevant literature, data complex condition. extraction was performed to gather important METHOD information regarding the mechanisms of carbamazepine-induced AV heart block, clinical This review of carbamazepine-induced presentation, diagnostic approaches, and atrioventricular (AV) heart block was conducted management options. Key variables extracted through a systematic literature search and analysis included patient demographics, drug dosages, of relevant studies, case reports, and clinical duration of therapy, co-administered medications, guidelines. The methodology consisted of several clinical manifestations of AV block, and outcomes key steps aimed at collating and synthesizing data following intervention. The data were organized regarding the mechanisms and management of this thematically to facilitate analysis, allowing for a serious adverse effect. clearer understanding of the various factors that Literature Search and Selection Criteria contribute to the development of AV heart block in A comprehensive literature search was performed patients receiving carbamazepine. https://www.theamericanjournals.com/index.php/tajmspr 2 THE USA JOURNALS THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH (ISSN – 2689-1026) VOLUME 06 ISSUE11 Mechanism Exploration Management Strategies The review extensively explored the proposed The management strategies for carbamazepine- mechanisms by which carbamazepine may induce induced AV heart block were assessed through a AV heart block. This included an examination of review of current clinical guidelines and pharmacological effects on cardiac ion channels, recommendations. This included examining the particularly sodium and potassium channels, and consensus on the discontinuation of how these effects might disrupt normal cardiac carbamazepine in cases of significant AV block, as conduction. Additionally, po