Intravenous theophylline - An alternative to temporary pacing in the management of bradycardia secondary to AV nodal block

OBJECTIVE: To report a case of bradycardia secondary to atrioventricular no dal block (AVNB) successfully treated with intravenous theophylline. Intrav enous theophylline was used as an alternative to temporary pacing in a pati ent with sepsis secondary to thermal injury. CASE SUMMARY: A 79-year-old white woman with significant cardiac history wa s admitted with 14.5% total body surface area burns after a house fire. Car diac events included intermittent episodes of sinus bradycardia complicated by the development of second degree AVNB and periods of sinus arrest. Intr avenous theophylline initiation maintained normal sinus rhythm without furt her episodes of sinus bradycardia or heart block, thus preventing the need for cardiac pacemaker placement. DISCUSSION: This is the first case published in the English-language litera ture describing the use of intravenous theophylline as an alternative thera py to temporary pacing in a patient with sepsis secondary to thermal injury . Bradyarrhythmic events in sepsis patients have been associated with catec holamine production increasing adenosine-formation. High concentrations of adenosine in the areas of the sinoatrial or atrioventricular nodal regions may induce sinus bradycardia or AVNB. Theophylline, an adenosine antagonist , has been identified as a treatment option for such bradyarrhythmic events . CONCLUSIONS: Theophylline, a methylxanthine derivative, may represent an al ternative to other pharmacologic therapies and temporary pacing in the trea tment of bradycardia secondary to AVNB. These agents may represent a pharma cologic alternative in patients in whom other pharmacologic strategies or c ardiac pacemaker insertion may be contraindicated.