背景:唑吡坦是一种非苯并二氮卓类催眠药,广泛用于治疗失眠。以前从未报道过心肌病患者的唑吡坦触发的心房颤动(AF)。
方法:一名患有Duchenne型肌营养不良相关心肌病的40岁男子试图自杀,并在唑吡坦过量后出现新发房颤。入院前一年,患者在每日步行1个月后,因胸部不适和疲劳而到我们的诊所就诊;心电图(ECG)和24小时动态心电图结果均未发现房颤.服用心脏药物后(地高辛0.125mg/天,螺内酯40毫克/天,呋塞米20毫克/天,比索洛尔5毫克/天,沙库巴曲/缬沙坦12/13毫克/天),他感觉好多了。在入院之前,从未通过随访期间的连续监测观察到AF。入院前16天,患者看了睡眠专家,并因失眠开始服用酒石酸唑吡坦片(10mg/天)治疗6个月;心电图结果显示无明显变化.入院前一晚,患者在争吵后通过过量服用40毫克唑吡坦试图自杀,导致了严重的嗜睡.一被录取,他的心电图显示新发房颤,需要立即停止唑吡坦。入院9小时后,房颤自发终止为正常窦性心律。随后几天的ECG和1个月随访时的24小时动态心电图结果显示未检测到AF。
结论:本研究提供了有价值的临床证据,表明唑吡坦过量可能诱发心肌病患者房颤。它是临床医生开唑吡坦处方时的重要警告,特别是对于有心脏病的患者。需要进一步的大规模研究来验证这一发现并探索唑吡坦和AF之间的机制。
BACKGROUND: Zolpidem is a non-benzodiazepine hypnotic widely used to manage insomnia. Zolpidem-triggered atrial fibrillation (AF) in patients with
cardiomyopathy has never been reported before.
METHODS: A 40-year-old man with Duchenne muscular dystrophy-related
cardiomyopathy attempted suicide and developed new-onset AF after zolpidem overdose. One year before admission, the patient visited our clinic due to chest discomfort and fatigue after daily walks for 1 month; both electrocardiography (ECG) and 24-hour Holter ECG results did not detect AF. After administration of cardiac medication (digoxin 0.125 mg/day, spironolactone 40 mg/day, furosemide 20 mg/day, bisoprolol 5 mg/day, sacubitril/valsartan 12/13 mg/day), he felt better. AF had never been observed before this admission via continuous monitoring during follow-up. Sixteen days before admission, the patient saw a sleep specialist and started zolpidem tartrate tablets (10 mg/day) due to insomnia for 6 months; ECG results revealed no significant change. The night before admission, the patient attempted suicide by overdosing on 40 mg of zolpidem after an argument, which resulted in severe lethargy. Upon admission, his ECG revealed new-onset AF, necessitating immediate cessation of zolpidem. Nine hours into admission, AF spontaneously terminated into normal sinus rhythm. Results from the ECG on the following days and the 24-hour Holter ECG at 1-month follow-up showed that AF was not detected.
CONCLUSIONS: This study provides valuable clinical evidence indicating that zolpidem overdose may induce AF in patients with
cardiomyopathy. It serves as a critical warning for clinicians when prescribing zolpidem, particularly for patients with existing heart conditions. Further large-scale studies are needed to validate this finding and to explore the mechanisms between zolpidem and AF.