Gabapentin Linked to Atrial Fibrillation in Young Patient: Case Report

Gabapentin, a widely prescribed medication for neuropathic pain and seizure disorders, has recently come under scrutiny due to its potential impact on the cardiovascular system. While its primary side effects are associated with the central nervous system, emerging evidence suggests a link between gabapentin and an increased risk of atrial fibrillation, particularly among elderly patients with preexisting heart conditions.

In a recent case study, a young African American male in his twenties presented at a chronic pain clinic with lumbar radiculitis, a condition causing pain along the lower back and legs. Four days after initiation of gabapentin treatment, an unexpected and alarming development occurred - the patient was diagnosed with atrial fibrillation, a condition characterized by irregular and often rapid heartbeats.

Laboratory tests conducted on the patient revealed no significant abnormalities, including normal blood counts, comprehensive metabolic panel, toxicology screen, and thyroid-stimulating hormone levels. However, transthoracic and transesophageal echocardiography unveiled a patent foramen ovale, a small hole in the heart that had gone undetected, along with a right-to-left shunt, which can potentially allow blood clots to bypass the lungs and travel to other parts of the body.

Medical intervention was promptly initiated, involving heart rate control using diltiazem and blood thinning medication apixaban. Within 24 hours of admission, direct current cardioversion was performed, successfully restoring the patient's heart rhythm to normal. Following the procedure, the patient was discharged with a regimen of diltiazem and apixaban. Notably, after one month, the patient's medication was adjusted, transitioning from apixaban to low-dose aspirin.

This case study raises concerns about the potential association between gabapentin and atrial fibrillation, even in young and otherwise healthy individuals. While the majority of existing evidence focuses on elderly patients with existing cardiac conditions, this instance highlights the need for heightened awareness and monitoring across a broader demographic.

As the use of gabapentin continues to rise as a substitute for opioids in managing pain, medical professionals and patients alike must remain vigilant about potential side effects, including those affecting the cardiovascular system.

Source:

Park, S. H., Hunter, K., Berry, H., & Martins, Y. C. (2023). Atrial fibrillation induced by gabapentin: a case report. In Journal of Medical Case Reports (Vol. 17, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s13256-023-03975-1