New onset atrial fibrillation due to amphetamine use in a young patient

Abstract

The Food and Drug Administration (FDA) label for amphetamine gives warning of serious cardiovascular events and risk of sudden death in patients with structural heart disease or other serious cardiac conditions. Literature review was unrevealing for linkage of amphetamine stimulants to atrial fibrillation specifically. Additionally, recreational use of amphetamines can cause electrical instability of the myocardium potentially leading to arrhythmias, although this is more typical in the setting of an underlying structural heart defect. We must rely on the diligence of the practitioner to evaluate all possible causes for a new onset arrhythmia, and possibly specifically ask about the off label use of these medications. There is clear documentation in the literature regarding myocardial infarction, stroke, and sudden death in adults using CNS stimulants. However, there is little data regarding specific arrhythmias, including atrial fibrillation, using these medications. Further studies need to be developed to assess the relationship between stimulant medications and atrial fibrillation, as well as guidelines for prescribing these medications to patients who may already be at risk for developing atrial fibrillation based on personal or family history.

Keywords

• Atrial fibrillation
• Amphetamine
• Stimulant

References

1. [1] Wilke T, Groth A, Mueller S, et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Eurospace. 2012; 15(4): 486-93. PMid:23220354 http://dx.doi.org/10. 1093/europace/eus333
2. [2] Potpara TS, Lip GYH. Lone atrial fibrillation: what is known and what is to come. Int J Clin Pract. 2011; 65(4): 446-57. PMid:21219558 http://dx.doi.org/10.1111/j.1742-1241. 2010.02618.x
3. [3] Mugmon M. Atrial flutter with aberrant conduction in a patient taking amphetamine salts and caffeine. J Community Hosp Intern Med Perspect 2012 Jan 26;1(4). doi: 10.3402/jchimp.v1i4.10663. Print 2011.
4. [4] Ghuran A, Nolan J. The cardiac complications of recreational drug use. West J Med. 2000; 173(6): 412-15. PMid:11112762 http://dx.doi.org/10.1136/ewjm.173.6.412