title: A left lateral accessory pathway unmasked by rivastigmine.
abstract: A 75-year-old woman was referred for advice regarding surface electrocardiographic modifications after the initiation of rivastigmine. In our patient, the baseline ECGs appeared perfectly normal. However, the initiation of a cholinesterase inhibitor unmasked a left lateral accessory pathway that had never been diagnosed before. Although cholinesterase inhibitors are known to increase vagal tone, the PR interval was shortened after rivastigmine administration, thus excluding this hypothesis to explain the appearance of the accessory pathway. Therefore, we hypothesized that cholinesterase inhibitors may have increased conduction velocity in the accessory pathway or in the atria.
authors.affiliation: Cardiology Department, University Hospital, Dijon, France; LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France. Electronic address: charles.guenancia@gmail.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Guenancia
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Fichot
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Garnier
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Montoy
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Laurent
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000175:diagnosis*; D000368:Aged; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000187:drug effects* / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects*; D006801:Humans; D015203:Reproducibility of Results; D000068836:Rivastigmine / Q000008:administration & dosage*; D012680:Sensitivity and Specificity
chemical_list: D000068836:Rivastigmine
keywords: Accessory pathway; Cholinesterase inhibitors; Electrocardiogram