Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2017; 5(5): 178-182
Published online May 16, 2017. doi: 10.12998/wjcc.v5.i5.178
Ticagrelor therapy and atrioventricular block: Do we need to worry?
Elia De Maria, Ambra Borghi, Letizia Modonesi, Stefano Cappelli
Elia De Maria, Ambra Borghi, Letizia Modonesi, Stefano Cappelli, Cardiology Unit, Ramazzini Hospital, 41012 Carpi (Modena), Italy
Author contributions: De Maria E contributed to conception and design of the work, drafting the article, final approval; Borghi A, Modonesi L and Cappelli S contributed to drafting and critical revision of the work, final approval.
Institutional review board statement: This case report/editorial was exempt from the Institutional Review Board standards at our Institution.
Informed consent statement: The patients involved in this study gave their oral informed consent authorizing use and disclosure of their protected health information. At our Institution informed oral consent is regarded as sufficient for case reports/editorial.
Conflict-of-interest statement: The authors report no relationships that could be construed as a conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Elia De Maria, MD, PhD, Chief of Arrhythmology Lab, Cardiology Unit, Ramazzini Hospital, Via Molinari 1, 41012 Carpi (Modena), Italy.
Telephone: +39-05-9659320 Fax: +39-05-9659387
Received: January 8, 2017
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

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.