Can gentamicin (an aminoglycoside antibiotic) use induce atrial fibrillation?

Can Gentamicin Cause Atrial Fibrillation?

No, gentamicin is not recognized as a cause of atrial fibrillation in current medical literature or guidelines. Gentamicin does not appear in comprehensive reviews of drug-induced atrial fibrillation, and there is no established mechanism linking aminoglycosides to AF development 1, 2, 3.

Evidence Review

Absence from Drug-Induced AF Literature

• The most comprehensive 2024 guideline on drug-induced atrial fibrillation extensively catalogs medications known to cause AF across multiple drug classes, but gentamicin and aminoglycosides are completely absent from these lists 1.

• A 2020 American Heart Association scientific statement on drug-induced arrhythmias similarly does not identify aminoglycosides as arrhythmogenic agents 2.

• A systematic 2004 review of drug-induced AF examining cardiovascular, respiratory, cytostatic, CNS, and genitourinary drugs found no association with aminoglycosides 3.

Gentamicin's Known Adverse Effects

• Gentamicin's primary cardiac-relevant adverse effect is electrolyte wasting, specifically causing renal magnesium and calcium loss 4.

• In healthy volunteers receiving standard-dose gentamicin (5 mg/kg IV), urinary fractional calcium excretion increased from 1.8% to 6.8% and magnesium excretion rose from 3.4% to 11.8%, but these effects were transient and did not alter serum electrolyte levels 4.

• Importantly, gentamicin did not affect potassium excretion in this study 4.

Theoretical Considerations

• While severe hypomagnesemia and hypokalemia are established risk factors for AF 1, 5, gentamicin-induced electrolyte disturbances are typically:

  • Transient and self-limited 4
  • Rarely symptomatic at standard doses 4
  • Not associated with potassium wasting 4

• If AF were to occur in a patient receiving gentamicin, consider alternative explanations first 1:

  • Underlying infection/sepsis (a known AF trigger)
  • Pre-existing cardiovascular disease 5
  • Concurrent medications with known AF risk 1
  • Other comorbidities (age >65, hypertension, heart failure, valvular disease) 1, 5

Clinical Approach

When AF Develops During Gentamicin Therapy

• Do not attribute AF to gentamicin unless all other causes are excluded 1, 3.

• Check electrolytes (magnesium, potassium, calcium) and correct any deficiencies, though this is standard AF management regardless of gentamicin use 1.

• Review the complete medication list for established AF-inducing drugs including fluoroquinolones (if co-prescribed), beta-agonists, theophylline, digoxin, or chemotherapeutic agents 1, 6.

• Evaluate for underlying cardiac disease, thyroid dysfunction, and acute illness as primary AF triggers 1, 5.

• Continue gentamicin if clinically indicated for serious infection, as there is no evidence supporting discontinuation for AF 1.

Prevention Strategy

• Monitor electrolytes in patients receiving prolonged gentamicin courses, particularly those with baseline renal dysfunction or concurrent diuretic use 4.

• Maintain awareness that the infection being treated (especially endocarditis) carries its own AF risk independent of antibiotic therapy 1, 5.