Sequential use of aminophylline and theophylline for the treatment of atropine-resistant bradycardia after spinal cord injury: a case report.

A 66-year-old Japanese man was brought to our emergency department after he was accidentally compressed into a lateral groove. Physical examination revealed pinprick sensory level of T4 and motor level of C7. On the 4th hospital day, electrocardiography suddenly showed sinus bradycardia of 33 beats/min. Bolus injection of 0.5 mg of atropine sulphate was not effective. Bolus injection of aminophylline was administered followed by continuous infusion. His heart rate increased and remained stable at 60 to 70 beats/min. Therapy was switched from aminophylline to oral theophylline and continued for about 5 weeks, with no recurrence of bradycardia. Use of xanthine derivatives is thought to be an effective, safe and simple treatment for spinal cord injury-induced bradycardia.