lacosamide and Atrial-Fibrillation

Lacosamide (LCM) is a well-tolerated and increasingly used second-generation AED, and side effects such as atrial fibrillation are rare and poorly characterized. Supported by a literature review, we share our experience of the management of the first reported case of cardioembolic cerebral infarcts in the context of de novo atrial fibrillation, which appeared following a 200-mg intravenous infusion of LCM for the treatment of non-convulsive status epilepticus. Case report and literature review using search items including "atrial fibrillation OR atrial flutter AND LCM" in the thesaurus of Medline. We found three cases of atrial fibrillation/atrial flutter secondary to LCM, one following a 200-mg intravenous infusion. In one patient, previous risk factors for atrial fibrillation were reported and another was started on warfarin; all required suspension of LCM for cessation of atrial fibrillation. Previous risk factors for atrial fibrillation in our patient were older age, male gender, obesity, hypertension, valvular disease, first-degree atrioventricular block and left anterior fascicle block. Atrial fibrillation appeared at the end of the infusion and ceased after a loading dose of amiodarone and suspension of LCM. Apixaban was initiated indefinitely five days later, and MRI showed four acute silent infarctions. The appearance of atrial fibrillation has severe therapeutic and clinical implications and the use of LCM might be reconsidered within a context of increased predisposition to developing atrial fibrillation. If atrial fibrillation appears, the drug should be discontinued and anticoagulation should be considered according to embolic risk. Further investigation is needed in order to better categorize the risk profile of lacosamide regarding atrial fibrillation.

Topics: Aged, 80 and over; Anticonvulsants; Atrial Fibrillation; Cerebral Infarction; Embolism; Humans; Infusions, Intravenous; Lacosamide; Male; Status Epilepticus

Lacosamide (LCM) is a novel antiepileptic drug that exerts a strong antiepileptic effect via slow inactivation of voltage-gated sodium channels. LCM has been approved by the Food and Drug Administration for treatment of partial seizures at doses up to 400mg/day. Clinical trials have employed doses up to 600mg/day. LCM has been associated with atrial fibrillation at high doses (600mg/day) in patients with diabetes who had risk factors for heart disease. To our knowledge, atrial flutter or atrial fibrillation has not been reported in people with epilepsy. We report atrial flutter/atrial fibrillation at high doses of LCM (600mg/day) in a patient with epilepsy who had no significant risk factors for heart disease, which resolved following discontinuation of LCM. The literature regarding LCM-related cardiac death and arrhythmia is discussed. Physicians should be aware of the potential cardiac effects of this novel antiepileptic drug.

Topics: Acetamides; Adult; Anticonvulsants; Atrial Fibrillation; Atrial Flutter; Electrocardiography; Epilepsies, Partial; Female; Humans; Lacosamide