case_images: PMC4206249_01
case_images: ECG results.. Notes: The ECG showed sinus bradycardia, AVB (A) and sinus arrest (B). The symptomatic bradycardia was observed almost 1 hour after the instillation of levobunolol hydrochloride solution (indicated by red arrows) (C). The red boxes refer to the occurrence of bradycardia.. Abbreviations: ECG, electrocardiogram; AVB, atrioventricular conduction block; HR, heart rate; RR, R-R interval; min, minimum; max, maximum; bpm, beats per minute; H, hour; M, minute.
case_images: cia-9-1741Fig1.jpg
case_images: PMC4206249_01_cia-9-1741Fig1.jpg
case_images: f1-cia-9-1741
case_images: He complained of fatigue, dizziness, and heart palpitations, and an electrocardiogram (ECG) demonstrated sinus bradycardia at a rate of 39 bpm (the day of hospitalization; Figures 1A and 2A). Holter was taken the second day after being admitted to our hospital, which showed sinus bradycardia, atrioventricular block (first degree), and sinus arrest (Figure 1B). The lowest heart rate was reached (25 bpm), approximately two hours after instillation of the eyedrops (Figure 1C).
case_images: The recovery of heart rhythm shown by ECG.. Notes: ECG demonstrated the recovery of sinus rhythm (A) after withdrawal of levobunolol hydrochloride solution compared to the drug-induced bradycardia (B).. Abbreviation: ECG, electrocardiogram.
case_images: cia-9-1741Fig2.jpg
case_images: PMC4206249_01_cia-9-1741Fig2.jpg
case_images: f2-cia-9-1741
case_images: He complained of fatigue, dizziness, and heart palpitations, and an electrocardiogram (ECG) demonstrated sinus bradycardia at a rate of 39 bpm (the day of hospitalization; Figures 1A and 2A). ECG and Holter. ECG showed normal heart rhythm (Figure 2B) and Holter showed sinus rhythm, with an average heart rate of 67 bpm (Figure 3B).
case_images: Holter results.. Notes: Holter recorded the minimum heart rate at 25 bpm with a long R-R interval of 3.5 seconds at 9:59 am, about 2 hours after the instillation of levobunolol hydrochloride solution (A). After 48 hours of withdrawal of levobunolol, Holter showed no obvious sinus arrest and the minimum heart rate was 37 bpm (B).. Abbreviation: bpm, beats per minute.
case_images: cia-9-1741Fig3.jpg
case_images: PMC4206249_01_cia-9-1741Fig3.jpg
case_images: f3-cia-9-1741
case_images: The average heart rate was 54 bpm and the range of heart rate varied from 25 bpm (Figure 3A) to 79 bpm. There were 265 episodes of sinus arrest lasting longer than 2 seconds and six arrests longer than 3 seconds (Figure 3A). ECG and Holter. ECG showed normal heart rhythm (Figure 2B) and Holter showed sinus rhythm, with an average heart rate of 67 bpm (Figure 3B).