Lithium-Induced Bradycardia

Introduction to Lithium-Induced Bradycardia

• Lithium can cause bradycardia, a documented adverse effect that can occur even at therapeutic levels, and the American College of Cardiology recommends considering this risk when initiating therapy 1

Diagnosis and Evaluation

• When bradycardia is detected in a patient on lithium, the American College of Cardiology recommends obtaining serum lithium levels, performing ECG to evaluate for bradyarrhythmias, AV blocks, or T-wave changes, and checking electrolytes, renal function, and thyroid function 1

Treatment of Lithium-Induced Bradycardia

• For acute symptomatic bradycardia, the American College of Cardiology recommends atropine 0.5-1 mg IV, which may be repeated every 3-5 min to a maximum of 3 mg, and if unresponsive, consider temporary pacing or pharmacologic agents such as dopamine, isoproterenol, or epinephrine 1

Cardiac Effects of Lithium

• Lithium can cause other cardiac effects, including T-wave changes and QT interval alterations, as reported by the European Heart Journal 2

Prevention and Monitoring

• Baseline ECG before starting lithium therapy, regular monitoring of lithium levels, and periodic ECG monitoring, especially in patients with cardiac risk factors, are recommended to prevent and detect lithium-induced bradycardia 2