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Journal of Postgraduate Medicine, Vol. 57, No. 3, July-September, 2011, pp. 221 Case Snippet Ginkgo biloba: An ancient tree with new arrhythmic side effects V Russo, A Rago, GM Russo, R Calabrò, G Nigro Department of Cardiothoracic and Respiratory Sciences, Chair of Cardiology, Second University of Naples, Code Number: jp11059 PMID: 21941062 A 35-year-old woman presented to our observation complaining of frequent nocturnal palpitations which subside after few minutes. Her body weight was 75 kg and her height was 170 cm. Physical examination revealed a blood pressure of 130/80 mmHg, clear lungs and normal heart sounds. Electrocardiographic (ECG) examination showed sinus rhythm of 80 beats/minute without conduction abnormalities or ST-T changes. Neither chest X-ray nor Doppler echocardiography revealed any cardiac structural or functional abnormalities. Hematological examination, urinary analysis and thyroid function were all normal. She had no past medical history and denied taking any medications. She reported a recently increased coffee intake (five cups daily). We suggested to suspend coffee assumption and to undergo 24 h-Holter ECG monitoring which showed four nocturnal episodes of paroxysmal atrial fibrillation. At the following visit, her husband mentioned that she was taking Ginkgo biloba leaf extract (240 mg/day), as general tonic, for the previous 2 months. We suspected a pro-arrhythmic effect of Ginkgo biloba and the drug was discontinued. After stopping Ginkgo biloba, the patient′s condition markedly improved and the following repeated 24 h ECG Holter did not show any arrhythmias over the next 12 months. A pro-arrhythmic effect of Ginkgo biloba in our patient is been strongly suggested by the temporal coincidence of atrial instability and Ginkgo biloba intake, and by the absence of any atrial fibrillation trigger. The complete symptoms resolution and the disappearance of atrial fibrillation episodes within days after Ginkgo discontinuation is in line with its pharmacokinetic. To date, little is known about the association between Ginkgo and arrhythmias. Cianfrocca et al.[1] described a possible association between Ginkgo biloba and frequent ventricular arrhythmias in a healthy 49-year-old man. Pfister et al.[2] reported a case of Ginkgo biloba induced electrical storm in old patient with ischemic cardiomyopathy. As per our knowledge, this is the first report to hypotize the association between the use of Ginkgo biloba and paroxysmal atrial fibrillation. Previous experimental studies [3],[4] support our clinical hypothesis by showing distinct effects of Ginkgo biloba and its constituents on action potential duration and cationic currents in rodent ventricular myocytes. Alteration of action potential duration facilitates the generation of reentry circuits that constitute the electrophysiological substrate for atrial fibrillation. [5] The possibility that Ginkgo biloba might favor atrial arrhythmias has been raised by Kubota et al. investigation [4] which showed positive chronotropic and inotropic actions in rat-isolated atria. We are aware that the relation between Gingko biloba and atrial fibrillation is anecdotal, but we trust that herbal medications use should be specifically asked in the pharmacological anamnesis of arrhythmological evaluation. Since the herbal preparation Ginkgo biloba leaf extract is promoted as a remedy for a wide range of conditions, further studies are necessary to assess the relationship between Gingko biloba use and arrhythmias. References
Copyright 2011 - Journal of Postgraduate Medicine |
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