MANIFESTATION OF LATENT SICK SINUS SYNDROME(SSS) BY LONG TERM ADMINISTRATION OF CARBAMAZEPINE IN AN AGED PATIENT

An 85-year-old male with trigeminal neuralgia had been treated with carbamazepine for about 20 years.About three months ago,he began to have episodes of a transient near syncope,and 24-hour electrocardiographic monitoring showed sinus arrest(5.9 sec).To evaluate sinus function,electrophysiological study was performed 12 days after discontinuation of carbamazepine. The sinus node recorvery time(SNRT)meseared at base-line state was normal,however the SNRT after denervation was 2,400 msec,suggesting the existence of latent sinus dysfunction.In this patient,latent sinus dysfunction appeared to be manifested by carbamazepine administration.Because carbamazepine was thought to be essential to his trigeminal neuralgia in this patient,a permanent dual-chamber pacing system(DDD mode)was implanted. Sick sinus syndrome may have been induced by the administration of carbamazepine in some patients.Therefore,in aged patients who often have latent sinus dysfunction,its administration particularly requires special caution by ECG and clinical sympton. (Tokyo Jikeikai Medical Journal 2002;117:193-8)