Cyclical sinus bradycardia and atrioventricular block induced by ticagrelor

Ticagrelor, a direct-acting and reversible P2Y12-adenosine diphosphate receptor antagonist, is recommended as a first-line antithrombotic agent in patients with acute coronary syndromes.1 The superiority of ticagrelor over other P2Y12 antagonists is thought to be mediated in part by pleiotropic properties associated with an increased concentration of adenosine, including cardioprotection, anticoagulant effects, and anti-inflammatory properties.2 However, these pleiotropic properties can also be responsible for major adverse effects, including electrophysiological consequences. Herein, we describe the case of a patient with severe cyclical sinus bradycardia and atrioventricular (AV) block related to ticagrelor.