Arrhythmias in Cancer and Cancer Treatment: A Review

Bradyarrhythmias in Cardio-Oncology

“…An increased vagal tone has also been proposed as a mechanism given that some patients have uncontrolled emesis associated with CHB. 5,6 Anthracyclines are traditionally associated with cardiomyopathy/left ventricular dysfunction, with arrhythmias resulting from the former. In a prospective study of patients receiving doxorubicin, 3.4% developed bradycardia detected by 24-hour Holter monitoring with one patient developing CHB requiring permanent pacing.…”

“…Cardiac accumulation of doxorubicinol, a toxic metabolite of doxorubicin, may be involved in some of these mechanisms. 5,6 Cisplatin infusion is associated with sinus bradycardia (SB) which can start immediately during infusion, can be marked, and tends to recur with each cycle. [8][9][10][11] Coronary vasospasm, endothelial damage, and electrolyte disturbances are postulated mechanisms for cisplatin cardiotoxicity.…”

“…[8][9][10][11] Coronary vasospasm, endothelial damage, and electrolyte disturbances are postulated mechanisms for cisplatin cardiotoxicity. 5,6 Cisplatin deposition in the sinoatrial (SA) node and the vasculature supplying it are likely to be the cause of the bradycardia. 8 There have been isolated case reports of SB related to 5-fluorouracil (5-FU) treatment with a published case series of six patients that developed asymptomatic SB with a heart rate below 50 bpm.…”

“…Another postulated mechanism is ischemia due to arteritis and/or thrombosis. 5,6 There is a paucity of data regarding bradycardia and other drugs of the antimetabolites class with only one case report of symptomatic SB with cytarabine. 16 The most common paclitaxel-related arrhythmia is SB, which can occur in as much as 29% of the patients (13 out of 45 patients in one prospective study) but is usually transient and asymptomatic.…”

“…Histamine-induced release can also cause bradycardia and atrioventricular (AV) conduction delays. 5,6 CHB requiring pacing to continue arsenic trioxide treatment has been described, but it is infrequent, and the most common described cardiotoxicity of this drug still is QT interval changes. 18 Arsenic trioxide increases Ca 2+ currents, inhibits K + channels, and reduces surface expression of the human ether-a-go-go-related K + channels, although these actions are more clearly related to the QTc changes previously mentioned.…”