Document Detail


Anti-N-methyl-D-aspartate receptor encephalitis: an emerging cause of centrally mediated sinus node dysfunction.
MedLine Citation:
PMID:  22345374     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) is a recently recognized form of autoimmune encephalitis that typically affects young women, often as a paraneoplastic syndrome related to ovarian teratoma. Clinical features include psychiatric and neurological disturbances, central hypoventilation, autonomic instability, and cardiac dysrhythmias. The prevalence, nature, and outcomes of cardiac dysrhythmias in patients with NMDARE have not been well described.
METHODS AND RESULTS: Records of 10 consecutive patients with NMDARE were reviewed to obtain clinical, laboratory, echocardiographic, electrocardiographic, and radiological data. Patients were all female with an average age of 23 ± 5.5 years. Echocardiograms revealed structurally normal hearts with the exception of mild left ventricular hypertrophy in two cases. Eight patients had inappropriate sinus tachycardia. Six patients developed significant sinus bradycardia, which included periods of sinus arrest in four cases. Five patients manifested both sinus bradycardia and tachycardia. Bradycardia was often triggered by identifiable vagal stimuli. Temporary pacing was instituted in three patients, but permanent pacing was not required in any of the patients. Magnetic resonance imaging (MRI) scans revealed mesial temporal abnormalities in nine patients. In all cases, the dysrhythmias resolved with treatment of the underlying immune disorder with immunotherapy and/or teratoma resection. There was no evidence of dysrhythmia recurrence in any patient at follow-up.
CONCLUSION: Anti-N-methyl-D-aspartate receptor encephalitis is a recently recognized cause of autoimmune encephalitis with a predilection to cause severe sinus node abnormalities. Temporary pacing is occasionally required, but permanent pacing appears to be unnecessary. An analysis of the clinical syndrome coupled with MRI and experimental data may offer insight into central mechanisms of heart rate regulation.
Authors:
Tamim M Nazif; Jesús Vázquez; Lawrence S Honig; José M Dizon
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-02-15
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  14     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-26     Completed Date:  2013-05-30     Revised Date:  2013-08-14    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  1188-94     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Department of Medicine, Columbia University Medical Center, Columbia University, 630 W 168th Street, New York, NY 10032, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / complications*
Arrhythmias, Cardiac / etiology*
Brain / pathology
Electrocardiography
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Sick Sinus Syndrome / etiology*
Young Adult
Grant Support
ID/Acronym/Agency:
P50AG008702/AG/NIA NIH HHS
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