Title: Recurrent atrial fibrillation after subcutaneous apomorphine
Abstract: It is with great interest that we have read the paper by Pfeiffer et al. [ [1] Pfeiffer R.F. Gutmann L. Hull Jr, K.L. Bottini P.B. Sherry J.H. The APO302 Study InvestigatorsContinued efficacy and safety of subcutaneous apomorphine in patients with advanced Parkinson's disease. Parkinsonism Relat Disord. 2007; 13: 93-100 Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar ] providing evidence for subcutaneous apomorphine as an effective and safe treatment for advanced Parkinson's disease. The most relevant adverse events reported were yawning, somnolence, dizziness, rhinorrhea and nausea. The authors also mentioned two patients who developed sinus tachycardia and atrial flutter but details of their history were not included. Only few other reports on heart arrhythmia after subcutaneous apomorphine in patients with Parkinson's disease appeared [ 2 Attanasio A. Capria A. Leggiadro G. Michisanti M. Cannata D. Stocchi F. et al. Transient cardiac arrest during continuous intravenous infusion of apomorpkìhine. Lancet. 1990; 336: 1321 Abstract PubMed Scopus (12) Google Scholar , 3 Stocchi F. De Pandis M.F. Delfino F.A. Anselmo T. Frongillo D. Transient atrial fibrillation after subcutaneous apomorphine bolus. Mov Disord. 1996; 11: 584-585 Crossref PubMed Scopus (10) Google Scholar ]. We report on a 65 years old man admitted to hospital for thoracic surgery for esophageal cancer who developed atrial fibrillation after subcutaneous apomorphine. The patient had a 6 years history of rigid-akinetic Parkinson's disease. He was on a daily dose of levodopa/carbidopa 600mg and dopamine agonist (pramipexole 2.1mg). He had no history of cardiac disease. He was affected by hypertension and treated with propranololo 5mg/day. On admittance the neurological examination disclosed hypomimia, mild camptocormia, bradikinesia, and left foot dystonia. On the day before surgery he replaced the oral treatment with subcutaneous apomorphine (Apofin®) in bolus at daily dose of 2mg q.i.d. with domperidone premedication (30min before), without any adverse event. The patient was EKG monitored continuously before and after surgery. The day after the surgery we observed atrial fibrillation 10–15min after apomorphine injection promptly treated with propaphenone with regression after 1h approximately. The apomorphine dose was reduced to 1mg q.i.d. The next day he experimented again atrial fibrillation 10–15min after apomorphine injection, resolving 1h after amiodarone therapy. Apomorphine was stopped and no other atrial fibrillation episodes were observed. There was no pulmonary complication or anastomotic leak. Only a moderate increase of PCR and leucocitosis were found for 4 days after surgery. Continued efficacy and safety of subcutaneous apomorphine in patients with advanced Parkinson's diseaseParkinsonism & Related DisordersVol. 13Issue 2PreviewThe study purpose was to assess the efficacy of intermittent subcutaneous apomorphine (APO) as acute therapy for off episodes in advanced Parkinson's disease (PD) patients who had previously received APO for ⩾3 months. Patients ( n = 62 ) were randomized to receive double-blind treatment with APO at their typically effective dose (TED; APO), APO at their TED+0.2mL (2.0mg; APO+2), placebo at volume equal to their TED (PL), or placebo at volume equal to their TED+0.2mL (PL+2), for a single off episode. Full-Text PDF CorrespondenceParkinsonism & Related DisordersVol. 14Issue 2PreviewWe thank Dr. Ardolino and his colleagues for their interest in our article and for their interesting report of recurrent episodes of atrial fibrillation in an individual receiving scheduled doses of apomorphine. Awareness of this will be of value to both patients and physicians. Full-Text PDF
Publication Year: 2007
Publication Date: 2007-07-14
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 6
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