Ingestion of polyethylene glycol (PEG)-based solutions for bowel preparation prior to colonoscopy may cause atrial arrhythmias in some patients, according to findings from a case series published in the Annals of Pharmacotherapy.

To investigate the potential for cardiac adverse events, the authors conducted a retrospective observational cohort study using electronic medical records of patients from the John D. Dingell VA Medical Center who developed supraventricular tachycardia (SVT) following ingestion of a PEG-based bowel prep solution (GoLYTELY) prior to colonoscopy.  A review of medical records revealed 16 patients with new-onset SVT (12 with atrial fibrillation, 3 with atrial tachycardia, and 1 with atrial flutter).

Findings showed that 93.8% (n=15) of the patients who developed SVT were male; the mean age of affected patients was 69 ± 8.2 years. Among these patients, common comorbidities included hypertension, hyperlipidemia, and diabetes and a significant percentage were observed to have dilated atria and left ventricular hypertrophy.  None of the patients had serum electrolyte abnormalities or thyroid stimulating hormone levels out of normal limits.

“We hypothesize that the combination of atrial dilation, sympathovagal discharge, and transient electrolyte shifts at the cellular level led to the development of SVTs,” the authors reported. “Because of the small sample size, it is difficult to derive definite conclusions from our study.”


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Additional study limitations included data collection through chart review, the study location (VA health care system) and patient population (predominately male), as well as a lack of a control group.

The current prescribing information for osmotic laxative products for colonoscopy prep includes a warning about use in patients at increased risk of arrhythmias, particularly those with a history of prolonged QT, uncontrolled arrhythmias, recent myocardial infarction, unstable angina, congestive heart failure, or cardiomyopathy. “Because one of the risk factors for developing SVT in our population was atrial dilation, it brings up the question about whether this specific structural cardiac abnormality should raise a similar level of caution prior to and during colonoscopy,” the authors noted.

Reference

Kajy M, Ramappa P. A galvanizing solution: Colonoscopy bowel preparation as a trigger for supraventricular tachycardia. Annals of Pharmacotherapy. Published online June 13, 2021. doi: 10.1177/10600280211023808