Abstracts

Rationale: BACKGROUND: Lacosamide, a relatively new anti-seizure medication, has been used for focal dyscognitive and secondarily generalized seizure disorder. The most serious side effects reported with lacosamide use are cardiac conduction disturbances, including dose-dependent PR interval prolongation and first degree AV block. To our knowledge there has been only one other case of sinus nodal dysfunction on lacosamide that has been reported in a patient with a prior history of sinus bradycardia. PURPOSE: To report a case of sinus nodal dysfunction on a relatively lower dose of lacosamide in a patient with no prior history of sinus nodal dysfunction. Methods: METHODS: Review of the clinical chart of a 83 year-old male with a history of a fall leading to subarachnoid hemorrhage (SAH) and seizures. The patient had a prior history of coronary artery disease and coronary angioplasty. On admission, he was noted to have a focal motor seizure. He was started on 100 mg twice a day of lacosamide for seizure prophylaxis. Within 2 days, he developed sinus bradycardia. His heart rate dropped to 20-30 beats per minute, with significant pauses of over 4 seconds noted on telemetry monitoring. Electrocardiogram (EKG) and routine laboratory testing did not show any signs of acute coronary ischemia. Temporary transcutaneous pacer was used to regulate the cardiac rhythm. Results: RESULTS: The heart rate improved within hours of discontinuing lacosamide. Conclusions: CONCLUSIONS: Our patient developed a relatively rapid, life-threatening cardiac complication with a low dose of lacosamide. He had a history of coronary artery disease, but no prior history of sinus dysfunction. The traumatic SAH he suffered probably increased his risk of cardiac complications on lacosamide. The intravenous availability of lacosamide has increased its usage in critical care settings. This report emphasizes the need to closely monitor individuals receiving lacosamide with a 12-lead EKG and continuous cardiac telemetry, especially in an older patient in a critical care setting.