Effects of first-dose doxorubicin on cardiac rhythm as evaluated by continuous 24-hour monitoring

Abstract

Doxorubicin has been reported to cause ventricular arrhythmias and sudden death in the first 24 hours after administration. The authors placed continuous electrocardiographic recording devices on 30 patients 24 hours before, during, and 24 hours after doxorubicin administration. Nine patients experienced arrhythmias before treatment; 12 patients had posttreatment ectopy. No patient had life-threatening arrhythmias before or after treatment. Of the nine patients with pretreatment ectopy, only one experienced an increase in severity. Conversely, six patients without ectopy before treatment had arrhythmias after doxorubicin administration. The authors were unable to determine predictive factors in patients with no pretreatment ectopy who developed posttreatment premature ventricular contractions. The authors conclude that antecedent ventricular ectopy exists in the oncologic population and that this is not worsened by first-dose exposure to doxorubicin.

Doxorubicin-induced second degree and complete atrioventricular block

“…Although it was considered that these rhythm disturbances causing mortality could be related to anthracycline infusion, drug-induced allergy or hypotension might also play a role in these serious adverse effects. In another study, it was described that seven out of 30 patients who received doxorubicin showed severe ventricular ectopy after their first dose of the drug [8]. Couch et al [14] reported sudden cardiac death one month after the completion of doxorubicin therapy.…”

“…Although these are usually non-specific electrocardiographic repolarization abnormalities, there can be serious rhythm disturbances that are associated with mortality in rare instances. Previous studies designed in adult patients have suggested that anthracyclines could cause various electrocardiographic abnormalities including T-wave inversion, ST segment elevation or depression, decreased QRS voltage, prolonged QT interval and arrhythmias including AV block, and supraventricular and ventricular arrhythmias [2,8]. These are usually transient and have no long-term clinical significance.…”

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

“…This form of cardiomyopathy can occur acutely soon after treatment, within a few months of treatment (the so-called subacute form), or many years later (1056,1060 -1066). There is an increase in ventricular ectopy in patients receiving doxorubicin during the acute infusion period, but this is very rarely of any significance (1067,1068). Some studies have suggested reduced HRV, abnormalities in area ratios on SAECG, and increased QTc may be indicators of impending cardiomyopathy and electrical instability, but these have yet to be substantiated (1066,1069,1070).…”

Long-Acting Phosphodiesterase-5 Inhibitor Tadalafil Attenuates Doxorubicin-Induced Cardiomyopathy without Interfering with Chemotherapeutic Effect

“…The heart failure caused by DOX is characterized by damage resulting from the disintegration of the myofibrillar array, mitochondrial injury, and cardiomyocyte apoptosis, leading to the loss of the myofibrils (Billingham et al, 1978). Reduction in fractional shortening and abnormalities in the nonspecific T wave and ST-T segment of EKG are typically observed in DOX-induced ventricular dysfunction (Friess et al, 1985). A variety of mechanisms have been suggested to contribute to DOX-induced cardiomyopathy and heart failure.…”