Acquired episodic complete heart block after high-dose chemotherapy with cyclophosphamide and thiotepa

Ramireddy, Karthik; Kane, Kevin M.; Adhar, Gur C.

doi:10.1016/0002-8703(94)90686-6

Cited by 11 publications

(3 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One reported case experienced advanced heart block after high-dose CY and etoposide, 10 while in the other complete heart block was induced by CY and TEPA. 11 These blocks developed a few days after the beginning of HDC, although they were transient in nature. Both patients had a transient loss of consciousness and required pacemaker implantation for treatment.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 However, high-grade heart block has rarely been reported. 10,11 In this study, we retrospectively reviewed our experience of cardiac toxicities induced by high-dose chemotherapy (HDC) including CY in patients with breast cancer. Our review of this well-known complication by continuous monitoring revealed a rather higher incidence of abnormalities in the conduction system.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cardiac conduction abnormalities in patients with breast cancer undergoing high-dose chemotherapy and stem cell transplantation

Ando

Yokozawa

Sawada

et al. 2000

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Cardiac toxicities in 39 consecutive patients with breast cancer receiving high-dose chemotherapy (HDC) with stem cell transplantation were reviewed. All 39 patients received various anthracycline-containing regimens in adjuvant settings and/or for metastatic disease before HDC. As a cytoreductive regimen, all received cyclophosphamide 2000 mg/m 2 and thiotepa 200 mg/m 2 for 3 consecutive days. No immediate fatal toxicities were observed, but one patient developed chronic congestive heart failure and two had transient left ventricular dysfunction. Pericardial effusion was observed in another three patients. ST-T abnormalities during HDC were observed in two patients and arrhythmias were observed in nine, four of which occurred during stem cell infusion (SCI). There were three atrial arrhythmias, two ventricular arrhythmias, and four atrioventricular (AV)-block episodes. Two patients developed advanced and complete AV-block with an asystolic pause. Notably, three patients experienced AV-block with uncontrolled vomiting. No relationship was observed between the cumulative dose of anthracycline and cardiac toxicities during HDC. These results suggest that abnormalities in the conduction system during HDC may be more frequent than previously reported. Vagal reflex secondary to emesis may play an important role in the development of AV-block. Bone Marrow Transplantation (2000) 25, 185-189. Keywords: high-dose chemotherapy; cyclophosphamide; advanced atrioventricular block; cardiac complications Cyclophosphamide (CY) is widely used in stem cell transplantation for its antineoplastic and myeloablative effects. In addition to well-known complications including a syndrome of inappropriate anti-diuretic hormone secretion and hemorrhagic cystitis, cardiac toxicity occurs at a high dose, and includes transient changes on electrocardiogram (ECG), arrhythmias, pericardial effusion, myocarditis and Correspondence: Dr K Tobinai, Department of Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan 2 Present address: First Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan Received 31 March 1999; accepted 27 July 1999 congestive heart failure (CHF). Cardiac toxicity caused by CY is often fatal. 1-9 The incidence of acute CHF was 17% to 28% in patients who received CY for bone marrow transplantation (BMT), [2][3][4][5]7 and this correlated with the dose of CY administered per day. 6,7 Concerning arrhythmias induced by CY, supraventricular and ventricular origins were commonly observed. 8,9 However, high-grade heart block has rarely been reported. 10,11 In this study, we retrospectively reviewed our experience of cardiac toxicities induced by high-dose chemotherapy (HDC) including CY in patients with breast cancer. Our review of this well-known complication by continuous monitoring revealed a rather higher incidence of abnormalities in the conduction system. Patients and methods Patients and pretransplant consolidation chemotherapyWe reviewed the...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cardiac conduction abnormalities in patients with breast cancer undergoing high-dose chemotherapy and stem cell transplantation

Ando

Yokozawa

Sawada

et al. 2000

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…Nevertheless, other reports of CHB required discontinuation of cyclophosphamide and/or temporary as well as permanent pacemaker implantation. 3 4 Arrhythmias related to alkylating agents are thought to arise from direct cardiotoxicity to myocytes and ischemic damage caused by coronary vasospasm and vascular endothelial injury with subsequent intracapillary microthrombi. An increased vagal tone has also been proposed as a mechanism given that some patients have uncontrolled emesis associated with CHB.…”

Section: Case 1: Bradycardia With Antithymocyte Globulinmentioning

confidence: 99%

Bradyarrhythmias in Cardio-Oncology

Fonseca

Cheng

et al. 2021

South Asian J Cancer

View full text Add to dashboard Cite

The relationship between bradyarrhythmias and cancer therapies has not been well described but is increasingly recognized. There have been extensive advances in oncological pharmacotherapy, with several new classes of drugs available including targeted agents, immune checkpoint inhibitors and CAR T cell therapy. This increasing repertoire of available drugs has revolutionized overall prognosis and survival of cancer patients but the true extent of their cardiovascular toxicity is only beginning to be understood. Previous studies and published reviews have traditionally focused on conventional chemotherapies and in arrhythmias in general, particularly tachyarrhythmias. The number of patients with both cancer and cardiovascular problems is increasing globally and oncologists and cardiologists need to be adept at managing arrythmia based scenarios. Greater collaboration between the two specialties including studies with prospective data collection in Cardio-Oncology are much needed to fill in knowledge gaps in this arena. This case-based review summarizes current available evidence of cancer treatment-related bradyarrhythmia incidence (including its different subtypes), possible mechanisms and outcomes. Furthermore, we propose a stepwise surveillance and management protocol for patients with suspected bradyarrhythmia related to cancer treatment.

show abstract