title: Hyperthyroid-induced atrial flutter-fibrillation with profound sinoatrial nodal pauses due to small doses of digoxin, verapamil, and propranolol.
abstract: Atrial fibrillation due to hyperthyroidism is characterized by a rapid ventricular response which is typically resistant to digoxin therapy. We report a patient with atrial flutter-fibrillation who developed cyclic sinus node dysfunction with profound ventricular pauses in response to small doses of digoxin, verapamil, and propranolol, which resolved with discontinuation of the medications. Caution is necessary to avoid paradoxical ventricular slowing when treating hyperthyroid-induced atrial fibrillation.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: J D
authors.initials: JD
authors.lastname: Talley
authors.forename: M S
authors.initials: MS
authors.lastname: Wathen
authors.forename: J W
authors.initials: JW
authors.lastname: Hurst
mesh_terms: D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000209:etiology*; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology*; D004077:Digoxin / Q000009:adverse effects; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications*; D008875:Middle Aged; D011433:Propranolol / Q000009:adverse effects; D014700:Verapamil / Q000009:adverse effects
chemical_list: D004077:Digoxin; D011433:Propranolol; D014700:Verapamil