Zoledronic acid and atrial fibrillation in cancer patients

Bilir

et al. 2017

ccmbm

SummaryIntroduction. There are controversial results in the risk of atrial fibrillation as well as arrhythmogenic potential of bisphosphonates. Method. 37 patients and 40 healthy controls were evaluated prospectively with regard to the cardiac side effects related to the use of zoledronic acid (ZA) and its effects on electrocardiography (ECG) parameters. Result. As the basal ECG results of the patients diagnosed with cancer compared with the control group, it was determined that QT maximum was significantly lower, QT minimum was significantly higher. However; it was determined that QT disp, P max, P min, and P disp values were not significantly different. There was no statistically significant difference in P max, P min, P disp, QT max, QT min, QT disp values of the ECG parameters measured from cancer patients, before and 60 minutes after ZA therapy. Conclusion. There were no significant alterations in ECG in the acute period, indicated that ZA had no arrhythmia potential in the early period in patients with no underlying cardiac disease. However: patients receiving ZA should be monitored more closely because of the risk of arrhythmia which may ensue due to hypocalcemia, hypomagnesemia, or other chemotherapeutics.

supporting

confidence: 51%

The effects of zoledronic acid on ECG: a prospective study on patients with bone metastatic cancer

Bilir

et al. 2017

ccmbm

“…The study reported an HR of 1.30 (95% CI: 1.18–1.43) for AF among bisphosphonate users compared with non-users, together with an increased risk of stroke. In contrast, a Turkish cross-sectional study, from a single outpatient clinic, of 124 patients with solid tumours and bone metastasis treated with IV bisphosphonates did not detect any AF/flutter episodes (Arslan et al , 2011). However, that study was clearly underpowered and its design precluded evaluation of new onset of AF/flutter.…”

Section: Discussionmentioning

confidence: 87%

“…In addition, little is known about the potential underlying mechanism. Most studies were based on osteoporotic patients, with few examining the association in cancer patients (Wilkinson et al , 2010; Arslan et al , 2011). In cancer patients, bisphosphonates are administered in doses up to 10 times higher than those used for osteoporosis treatment.…”

mentioning

confidence: 99%

Intravenous bisphosphonate therapy and atrial fibrillation/flutter risk in cancer patients: a nationwide cohort study

et al. 2011

Background:There is conflicting evidence regarding bisphosphonates and atrial fibrillation (AF) risk in osteoporosis patients. However, bisphosphonates are used in much higher doses in treatment of bone metastasis and hypercalcemia, but little is known about the AF risk in cancer patients.Methods:We conducted a nationwide population-based cohort study using Danish databases. All cancer patients exposed to intravenous bisphosphonates during 2000–2008 were matched with two non-exposed cancer patients by cancer type, distant metastasis presence at diagnosis, age, and gender. We used Cox proportional hazard regression to estimate hazards ratios (HRs) of AF/flutter adjusting for important confounding factors.Results:Of the 3981 cancer patients exposed to intravenous bisphosponates, 128 (3.2%) developed AF/flutter. This condition occurred in 192 (2.4%) of the 7906 non-exposed cancer patients, corresponding to an adjusted HR of 1.7 (95% CI: 1.2–2.4).Conclusion:Intravenous bisphosphonates may increase AF/flutter risk in cancer patients.

“…They reported increased atrial and ventricular premature complexes during and after ZA infusion compared to basal recordings obtained before drug infusion. However, Arslan et al (14) did not demonstrate an increased risk of AF in a similar study population, using standard 12-lead electrocardiography (ECG) recordings.…”

Section: Discussionmentioning

confidence: 89%

Acute effect of zoledronic acid infusion on atrial fibrillation development in patients with osteoporosis

İlgezdi

Aktaş²,

Metin³

et al. 2015

Anatol J Cardiol

Objective:There is ongoing controversy related to the relationship between bisphosphonates and atrial fibrillation (AF). Our aim in this study was to evaluate the potential acute effect of zoledronic acid (ZA) infusion on AF development by using 24-hour Holter recordings.Methods:The study was designed to be a self-controlled case series study, and 33 consecutive patients with osteoporosis (29 females, age: 62.3±9.0 years) who were scheduled to receive ZA infusion constituted the study population. Patients underwent 24-hour Holter rhythm recordings at two different times; the first one was 48 hours before the planned ZA infusion, and the second one was on the morning of the infusion day. Heart rate, frequency and type of arrhythmias, as well as heart rate variability (HRV) from the two recordings were compared.Results:There were no episodes of AF greater than 30 sec in any of the 24-hour Holter recordings obtained before and on the day of drug infusion. Holter recordings before drug infusion showed that only 1 patient had an atrial run of 3 beats long. Holter recordings obtained on the day of drug infusion revealed that 5 patients (15.2%) had atrial runs with lengths ranging between 3 and 12 beats (p=0.046). Regarding HRV variables, SDANN values were found to be significantly depressed on the day of ZA infusion (113.6±26.9 vs. 98.2±29.9, p=0.007).Conclusion:None of the patients developed AF during or early after ZA infusion. However, there was an increase in atrial ectopy in some patients, which might be due to alterations in cardiac autonomic activity.