Abdominal Wall Fibrillation: Drug-Induced Causes
Critical Clarification
"Abdominal wall fibrillation" is not a recognized medical entity in the cardiovascular or neurological literature. The term appears to be a misunderstanding or conflation of two distinct phenomena: fasciculations (muscle twitching) of the abdominal wall musculature, or atrial fibrillation (a cardiac arrhythmia). The provided evidence addresses atrial fibrillation and fasciculations separately, but no medication is documented to cause "abdominal wall fibrillation" as a specific syndrome.
If Referring to Abdominal Wall Fasciculations
Succinylcholine is the primary medication that causes visible muscle fasciculations, including in the abdominal wall, with an incidence of 95% in untreated patients. 1
Mechanism and Clinical Context
Succinylcholine, a depolarizing neuromuscular blocker used during anesthesia induction, causes widespread fasciculations across all skeletal muscle groups including the abdominal wall through sustained depolarization of the motor endplate 1
The fasciculations occur immediately after administration and precede paralysis 1
Prevention strategies include pretreatment with nondepolarizing muscle relaxants, lidocaine, or magnesium (number needed to treat 1.2-2.5) 1
Other Medications Affecting Neuromuscular Function
Anticholinesterase inhibitors (neostigmine, pyridostigmine) can prolong succinylcholine-induced fasciculations when used for reversal 2
Phenytoin and carbamazepine may cause resistance to neuromuscular blocking drugs, potentially altering fasciculation patterns 2
If Referring to Drug-Induced Atrial Fibrillation
Numerous cardiovascular and non-cardiovascular medications can trigger atrial fibrillation, though this is a cardiac arrhythmia unrelated to the abdominal wall. 3
High-Risk Medications for Atrial Fibrillation
Theophylline increases atrial automaticity and shortens atrial action potential duration/effective refractory period, predisposing to arrhythmias 4
Class Ia and Ic antiarrhythmics (flecainide, propafenone, quinidine) paradoxically induce pro-arrhythmic effects including atrial fibrillation 4, 5
Macrolide antibiotics (erythromycin, clarithromycin, azithromycin) directly block cardiac potassium channels causing QT prolongation and arrhythmias 4
Digoxin toxicity produces enhanced atrial automaticity often combined with AV block when levels exceed 2 ng/mL 4
Important Clinical Pitfall
Do not confuse visible abdominal wall muscle twitching (fasciculations) with cardiac arrhythmias (atrial fibrillation). These are entirely separate pathophysiological processes requiring different diagnostic and therapeutic approaches. Fasciculations are visible or palpable muscle contractions in the abdominal wall itself, while atrial fibrillation is an irregular heart rhythm detected by ECG or pulse examination 6, 3.