**8. Conclusion**

Cardiac arrhythmia presents a potential dangerous complication leading to sudden cardiac death threatening young population. The most important mechanisms implicated in the genesis of arrhythmia in case of illicit drug intoxication are sodium channel blockade, potassium channel blockade, catecholamine excess, and finally myocardial infarction and myocarditis. Atrial fibrillation onset in young patients without structural heart disease should pay attention to an eventual illicit drug abuse. Its identification is very important because drug cessation will protect against atrial fibrillation recurrences. **Table 1** resumes physiopathological effects and main induced arrhythmias of commonly abused illicit drugs. Management should consist, first, on withholding drug intoxication with the collaboration of a detoxification center to prevent recurrent events, and, second, on common recommended measures as for the treatment of nondrug abuse arrhythmias with respect of some particularities and contraindications as in the case of cocaine intoxication. Thus, acute management of wide QRS tachycardia related to sodium channel blockade secondary to drug abuse, include oxygenation, sedation with benzodiazepine, and hypertonic sodium bicarbonate perfusion. Class IA and class IC antiarrhythmic drugs and betablockers are classically contraindicated. Electrical cardioversion is indicated in case of all hemodynamically unstable arrhythmias.

**Conflict of interest**

Heroine and morphine

methadone

**Author's contribution**

All authors conceived, read, and approved the final manuscript.

**Illicit drug Physiopathological effects Induced cardiac arrhythmias** Cocaine Sodium channel blockade QRS enlargement with right bundle

Cocaine-induced desensitization of beta-

adrenergic receptors

Cannabis Increase in sympathetic activity Sinus tachycardia

Methamphetamine and ecstasy Catecholamine excess Sinus tachycardia

LSD and psilocybin Mild catecholamine excess Sinus tachycardia

**Table 1.** Physiopathological effects and main induced arrhythmias of commonly abused illicit drugs.

sympathetic activity

Increase parasympathetic and reduce

Potassium channel blockade QT prolongation

Catecholamine excess Sinus tachycardia

Increase in parasympathetic activity Sinus bradycardia

Myocardial infarction/myocarditis Ventricular tachycardia/fibrillation

Myocardial infarction Ventricular tachycardia/fibrillation

Myocardial infarction Ventricular tachycardia/fibrillation

Sodium channel blockade Brugada-like syndrome

Potassium channel blockade QT prolongation

branch block

Drug Abuse-Induced Cardiac Arrhythmias: Mechanisms and Management

Brugada-like syndrome

http://dx.doi.org/10.5772/intechopen.76022

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Supraventricular tachycardia

Premature ventricular beats

Vasovagal and postural syncope

Supraventricular tachycardia

Atrial or ventricular ectopy

Sinus bradycardia

Torsade de pointes

Atrioventricular block

Sinus asystole

Torsade de pointes

Sinus bradycardia

Atrial fibrillation

None declared.


**Table 1.** Physiopathological effects and main induced arrhythmias of commonly abused illicit drugs.
