Cor Vasa 2025, 67(1):60-65 | DOI: 10.33678/cor.2024.060

Persistent Severe Bradyarrhythmia Following Donepezil Discontinuation in Dementia Patient: A Case Report and Literature Review

Okky Wahyu Firmansyah^a, Budi Baktijasa Dharmadjati^a, Rerdin Julario^a, Chabib Fachry Albab^b, Pandit Bagus Tri Saputra^a, Emil Prabowo^a

^a Department of Cardiology and Vascular Medicine, Airlangga University, Surabaya, Indonesia

^b Faculty of Medicine, Airlangga University, Surabaya, Indonesia

Background: Donepezil is an acetylcholinesterase inhibitor used in Alzheimer's disease management. It improves clinical symptoms but carries risks of orthostatic hypotension and bradycardia. Uncommon severe bradyarrhythmias post-discontinuation deserve attention. In addition, there have been no previous case reports regarding severe bradyarrhythmias post donepezil discontinuation. Case presentation: We report a case of a 33-year-old woman with a history of recurrent fainting. She has dementia and regularly takes donepezil. She experienced severe bradyarrhythmia with heart rate of 45 beats per minute regular on dopamine 5 µg/kg/min and unresponsive to atropine. The discontinuation of donepezil did not improve asymptomatic bradycardia. The use of temporary pacemaker (TPM) improved the patient's condition, then permanent pacemaker (PPM) was implanted.

Conclusions: This case report highlights donepezil's link to severe bradyarrhythmia in dementia patients. It stresses the challenges in managing adverse effects, suggesting that stopping donepezil and anticholinergic therapy may not always be sufficient and pacemaker implantation may be required.

Keywords: Bradyarrhytmia, Case report, Dementia, Discontinuation, Donepezil

Received: July 1, 2024; Revised: July 1, 2024; Accepted: July 28, 2024; Prepublished online: June 2, 2012; Published: March 1, 2025  Show citation