1413 - From Spine to Heart, A Case Report on Dexamethasone-induced Atrial Fibrillation

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

TH

Tahreem Hashmi, D.O.

Resident Physician PGY-3
Memorial Healthcare System
Cooper City, Florida, United States

Co-Author(s)

CE

Christiania V. Edstrom, MD

Resident physician
Memorial Hospital System
Cooper City, Florida, United States

Corresponding Author(s)

RY

Reed Yaras, D.O.

Interventional Pain Specialist
Memorial Healthcare System
Hollywood, Florida, United States

Submitter(s)

TH

Tahreem Hashmi, DO

Memorial Healthcare System
Cooper City, Florida, United States

Case Diagnosis: Paroxysmal atrial fibrillation in setting of recent lumbar transforaminal steroid injection

Case Description: 82-year-old female presented with left sided low back pain that was initially thought to be secondary to SI joint but did not improve with corticosteroid injection. MRI lumbar imaging revealed moderate to severe L5 foraminal disc herniation. Therefore, L5-S1 lumbar transforaminal epidural steroid injection (TFESI) using 2 mL 1% Lidocaine and 10mg dexamethasone. The following day, the patient went to the ER and was admitted for hypotension and new-onset atrial fibrillation (A-fib) with rapid ventricular response (RVR), requiring ablation. She was subsequently started on eliquis and due to treatment of A-fib, became bradycardic, requiring a pacemaker. Chart review demonstrated a similar episode of A-fib shortly after cervical TFESI with dexamethasone. She did receive a sacroiliac injection with Kenalog and Lidocaine that did not cause cardiac arrhythmias.

Discussions: It is documented and studied that high dose corticosteroids, typically around doses of 40mg daily can increase risk of A-fib. Multiple studies demonstrate the dosage is a contributing factor, rather than duration of steroid course. There is a dose dependent mineralocorticosteroid response with dexamethasone that is a possible pathophysiological explanation to this phenomenon along with known risk factors such as previous cardiac history, bronchial asthma, COPD, rheumatic disease. Epidural anesthesia for surgeries have shown some contribution to development of A-fib suspected due to an imbalance of sympathetic-parasympathetic systems with already known risk factors present in patients contributing to their presentation. It is not well documented regarding specifically epidural steroid injections (ESI) using dexamethasone can contribute to this presentation.

Conclusions: This case highlights a unique presentation of specifically dexamethasone leading to A-fib in this patient on multiple occasions. Limited data regarding this association warrants further investigation and possible need for further cardiac history investigation for pre-procedural planning of interventional strategies.