Abstract
Infliximab, a chimeric monoclonal immunoglobulin antibody to tumor necrosis factor (TNF)-α is widely used in the treatment of rheumatoid arthritis (RA). The commonly reported cardiac side effects of infliximab include ex-acerbation of congestive heart failure, hypotension, and syncope. Cardiac arrhythmia and conduction disturbances have been reported only rarely in a few case reports and to the best of our knowledge, there are no previous reports on the occurrence of atrial fibrillation secondary to infliximab use in RA patients. Here, we report a case of acute atrial fibrillation with rapid ventricular response that occurred 24 hr after first dose of infliximab in a 55-year-old female patient with RA, who recovered to sinus rhythm after pharmacologic management.
References
1. Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, et al. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet. 1999; 354:1932–9.
2. Smolen JS, Aletaha D, Koeller M, Weisman MH, Emery P. New therapies for treatment of rheumatoid arthritis. Lancet. 2007; 370:1861–74.
3. Knight DM, Trinh H, Le J, Siegel S, Shealy D, McDonough M, et al. Construction and initial characterization of a mouse-human chimeric anti-TNF antibody. Mol Immunol. 1993; 30:1443–53.
4. Anand C. Heart block occurring during infliximab infusion: a report of two cases. Am J Gastroenterol. 2003; 98:S144.
5. Sood A, Midha V. Symptomatic sinus bradycardia with infliximab. Indian J Gastroenterol. 2004; 23:118–9.
6. Sofos S, Savoye G, Ramirez S, Bauer F, Lerebours E. Transient type III atrioventricular block after infliximab infusion in a fistulizing perianal Crohn's disease patient. Am J Gastroenterol. 2007; 102:217–9.
7. Sote Y, Green S, Maddison P. Complete heart block after infliximab therapy. Rheumatology (Oxford). 2008; 47:227–8.
8. Singh M, Diwan MM, Patel KC. A rare case of supraventricular tachycardia induced by Infliximab: a case report. Cases J. 2009; 2:147.
9. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010; 62:2569–81.
10. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. Task Force on Practice Guidelines, American College of Cardiology/American Heart Association; Committee for Practice Guidelines, European Society of Cardiology; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation- ex-ecutive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiolo-gy Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Eur Heart J. 2006; 27:1979–2030.
11. Lazzerini PE, Acampa M, Hammoud M, Maffei S, Capecchi PL, Selvi E, et al. Arrhythmic risk during acute infusion of infliximab: a prospective, single-blind, place-bo-controlled, crossover study in patients with chronic arthritis. J Rheumatol. 2008; 35:1958–65.
12. Wooten MD, Reddy GV, Johnson RD. Atrial fibrillation occurring in a patient taking etanercept plus methotrexate for rheumatoid arthritis. Del Med J. 2000; 72:517–9.
13. Boyer JF, Jamard B, El Mahou S, Laroche M, Mazières B, Cantagrel A, et al. New-onset acute heart failure and ventricular tachycardia after therapy with a tumor necrosis factor antagonist. Clin Exp Rheumatol. 2005; 23:274–5.
14. Arai Y, Tadokoro J, Mitani K. Ventricular tachycardia associated with infusion of rituximab in mantle cell lymphoma. Am J Hematol. 2005; 78:317–8.
15. Poterucha JT, Westberg M, Nerheim P, Lovell JP. Rituximab-induced polymorphic ventricular tachycardia. Tex Heart Inst J. 2010; 37:218–20.