Dr Spodick points out that pericardial effusions of mixed causes are not a common cause of arrhythmias in the absence of co-existent anatomic heart disease.1-3 Our extrapolation from pathways of pancreatic pseudocyst drainages to analogies concerning arrhythmias seen in some cases of acute pancreatitis was misleading, since our article focused on intrathoracic pancreatic drainage pathways into the mediastinum and pleuropericardial cavities, and did not refer to observations made in cases of acute pancreatitis.4 We speculated that these pathways, should they be operative in some cases of acute pancreatitis, could offer another explanation for the occasional arrhythmias associated with pancreatitis. These arrhythmias have been previously attributed to stress, hypovolemia, and electrolyte disturbances,5,6 or co-existent heart disease.1,3
Conventional wisdom has perhaps overspeculated that pericardial inflammation can trigger rhythm disturbances by involving the sinus node.5,6 However, drainage of pancreatic enzymes capable of causing intense tissue inflammation7,8 into the pericardium could possibly be different
Louie S, Cross CE. Pericarditis: Not a Cause of Arrhythmias-Reply. Arch Intern Med. 1986;146(1):207–208. doi:10.1001/archinte.1986.00360130249046
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