Cardiac arrhythmias after cisplatin infusion: Three case reports and a review of the literature

Tassinari, Davide; Sartori, Sergio; Drudi, G.; Panzini, Ilaria; Giannì, L.; Pasquini, E.; Abbasciano, Vincenzo; Ravaioli, Alberto; Iorio, Domenico

doi:10.1023/a:1008231521553

Cited by 32 publications

(21 citation statements)

References 30 publications

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“…These symptoms have been described for patients who underwent testicular cancer therapy with DDP-based regimens (7). Tassinari et al (8) described three cases of patients experiencing sudden atrial fibrillation following DDP infusion. In the available literature, to the best of our knowledge, there have been only two descriptions of DDP-induced bradycardia (9,10).…”

Section: Discussionmentioning

confidence: 99%

Bradycardia as a rare symptom of cisplatin cardiotoxicity: A case report

Kucharz

Michałowska-Kaczmarczyk

Zygulska

et al. 2016

Oncology Letters

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Abstract. Cisplatin (DDP) is one of the most frequently used chemotherapeutic agents, and has a characteristic toxicity profile. For DDP, complications affecting the cardiovascular system, which are typical for certain other agents, are rare; however, their occurrence may lead to life-threatening conditions. To the best of our knowledge, there are few reported cases of DDP-induced bradycardia in the relevant medical literature. The current report presents the case of a 58-year-old patient diagnosed with metastatic neuroendocrine carcinoma with a primary lesion in the posterior mediastinum, who was treated with DDP and etoposide chemotherapy. Following the initial chemotherapy cycle, the patient experienced severe symptomatic bradycardia (a drop in heart rate to 40 bpm), with the corrected QT interval prolonged to 424 msec. The patient's condition required close monitoring and treatment. Similar symptoms occurred following each of the three cycles of chemotherapy. Imaging studies performed following the third treatment cycle revealed disease progression, and the patient was referred for palliative care. Reports have indicated that damage to the cardiovascular system, including cardiac ischemia, diastolic disturbances, hypertension and microalbuminuria, may be associated with DDP-based therapy. However, the mechanism of DDP-associated cardiac toxicity remains to be elucidated. It may be induced by factors including direct toxicity, ion imbalance, heart infiltration and, in the case of neuroendocrine tumors, the influence of tumor excretions.

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Section: Discussionmentioning

confidence: 99%

Bradycardia as a rare symptom of cisplatin cardiotoxicity: A case report

Kucharz

Michałowska-Kaczmarczyk

Zygulska

et al. 2016

Oncology Letters

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“…There is not enough data about the pathogenesis of arrhythmia caused by cisplatin infusion. Entire spectrum of arrhythmia, including supraventricular tachycardia, bradycardia and block in any degree may be observed during or shortly after cisplatin administration, some of them being clinically important and may cause death [5][6][7][8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

“…Although cisplatin has been used in the treatment of common cancers, there is no enough clinical evidence regarding the cardiotoxicity of this drug. There are some case reports of arrhythmia including supraventricular tachycardia, bradycardia and conduction abnormalities caused by cisplatin infusion in the literature [5][6][7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Recurrent Bradycardia Episodes Induced by Cisplatin Infusion

Çabuk¹,

Demır²,

Yaylacı³

et al. 2013

Sakarya Med J

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Chemotherapy may induce entire spectrum of cardiac pathology. Cisplatin has been used in oncology practice for a long time, but no sufficient clinical evidence exists about arrhythmogenic potential of this drug. We report a rarely diagnosed case of asymptomatic bradycardia probably induced by cisplatin infusion. In December 2010, a 28 years of woman was diagnosed with Sertoli-Leydig cell tumor. Three courses of BEP (bleomycine, etoposide, and cisplatin) chemotherapy was planned because of the poor prognostic factors. During the third course of chemotherapy, she had bradycardia during cisplatin infusion on routine vital sign assesments. Her physical examination including blood pressure was within normal limits. Electrocardiogram (ECG) revealed sinus bradycardia (40 beats/min). The patient had no clinical symptoms consistent with vagal stimulation. Blood pressure remained normal during and after the bradycardia episode. Concomitant serum concentrations of urea, creatinine, and electrolites (sodium, potassium, calcium, chloride, and magnesium) were within normal ranges. Her chemotherapy was terminated and 24-hour holter ECG was performed to reveal the bradycardia episodes. She had asyptomatic bradycardia during the records of holter ECG. After a few days of follow up her bradycardia episodes resolved. It was worthwile for this case presentation because the patient presented with asymptomatic bradycardia after cisplatin infusion. Cisplatin-induced sinus bradycardia is an unusual adverse effect with underlying mechanisms that remain to be clarified.

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“…In the clinical cases identified in which tachycardia was reported, the majority of patients were receiving a combination of intravenous cisplatin and etoposide to treat various cancers (Raja et al, 2013;Tassinari et al, 1997;Yavas et al, 2008;Fassio et al, 1986). In some cases, tachycardia (130 -230 bpm) was reported to have developed within a few minutes of cisplatin infusion in the first cycle of chemotherapy as well as in each consecutive cycle, while in others it developed on other days in the first, second or sixth cycle (Raja et al, 2013;Tassinari et al, 1997;Yavas et al, 2008;Fassio et al, 1986).…”

Section: Tachycardiamentioning

confidence: 99%

“…Results found that the only significant change in some cases was the level of Mg in which it was reduced to 1.2 -1.6 mg/dl (normal range of 1.7-2.2 mg/dl.) and in a few cases a reduction of both Mg and K levels were described (Tassinari et al, 1997;Yavas et al, 2008;Fassio et al, 1986). In a report by Tassinari et al, a 68 year old patient receiving intravenous 100 mg/m 2 cisplatin plus 100 mg/m 2 etoposide for the treatment of stage III B non-small cell lung cancer (NSCLC) complained of palpitations immediately after cisplatin infusion on day one of the first cycle (Tassinari et al, 1997).…”

Section: Tachycardiamentioning

confidence: 99%

Cisplatin induced arrhythmia; electrolyte imbalance or disturbance of the SA node?

Oun

Rowan

2017

European Journal of Pharmacology

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Since its approval in 1979 cisplatin has become one of the most extensively used chemotherapeutics in the clinic and although cell resistance and toxicity hinder its efficacy it continues to be a gold standard regimen. Cisplatin's side effects primarily include nephrotoxicity, gastrointestinal toxicity, neurotoxicity and ototoxicity.Cardiotoxicity is generally not defined as a side effect of cisplatin. However, over the past decade there has been a surge in the amount of clinical cases reporting a vast array of cardio-toxic events occurring during or shortly after cisplatin infusion, these range from angina to cardiac ischemia and chronic heart failure. This review intends to discuss the clinical cardiac manifestations of cisplatin specifically tachycardia and bradycardia which can be lethal and the possible mechanisms of action.

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Cardiac arrhythmias after cisplatin infusion: Three case reports and a review of the literature

Cited by 32 publications

References 30 publications

Bradycardia as a rare symptom of cisplatin cardiotoxicity: A case report

Bradycardia as a rare symptom of cisplatin cardiotoxicity: A case report

Recurrent Bradycardia Episodes Induced by Cisplatin Infusion

Cisplatin induced arrhythmia; electrolyte imbalance or disturbance of the SA node?

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