Published online May 16, 2017. doi: 10.12998/wjcc.v5.i5.178
Peer-review started: January 12, 2017
First decision: February 17, 2017
Revised: February 20, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: May 16, 2017
Core tip: Ticagrelor is a potent, direct antiplatelet agent with rapid onset of action and intense platelet inhibition, indicated in patients with acute coronary syndromes (ACS). Even if well tolerated, some patients experience bradyarrhythmias complications, especially sinus bradycardia and sinus arrest. This effect is usually transient, asymptomatic and not associated with higher incidence of severe atrioventricular block. However, recent articles have described ACS patients with high-degree atrioventricular block requiring drug discontinuation and, in some cases, pacemaker implantation. In this paper, we describe and discuss five published reports and two other cases managed in our Hospital. We conclude that, although rarely, ticagrelor can be associated with life-threatening atrioventricular block. Caution and careful monitoring are required especially in patients with already compromised conduction system and/or treated with atrioventricular blocking agents. Future studies, with long-term rhythm monitoring, would help to define the outcome of patients at higher risk of developing this complication.