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We read with interest the review article by Drs Moudgil and Yeh exploring the various molecular mechanisms through which cancer therapy can lead to cardiac toxicities.
Specifically, we were interested in the relationship between arrhythmias and cancer chemotherapeutic agents.
We recently published a retrospective study looking at rates of ventricular arrhythmia (ventricular tachycardia [VT] or ventricular fibrillation [VF]) in patients with implantable cardioverter defibrillators (ICDs) and a diagnosis of cancer.
Enriquez A, Biagi J, Redfearn D, et al. Increased incidence of ventricular arrhythmias in patients with advanced cancer and implantable cardioverter-defibrillators. JACC EP, in press.
We found that in patients who were diagnosed with cancer after ICD implantation, the frequency of ventricular arrhythmias (VT and VF) significantly increased after the cancer diagnosis to 1.19 ± 0.32 episodes per month compared with 0.12 ± 0.21 episodes per month before the diagnosis, which represents a 10-fold increase in arrhythmia burden (P = 0.031). The most common malignancies were skin (25%), prostate (12%), and breast (12%). The incidence of ventricular arrhythmia was significantly higher in patients with stage IV metastatic cancer than in those with earlier stages (I-III) (P = 0.03) (Fig. 1).
Figure 1Kaplan-Meier curve showing survival free of ventricular tachycardia/ventricular fibrillation (VT/VF) after diagnosis of cancer in patients with stage IV disease versus patients without systemic dissemination (stages I- III; log-rank P = 0.033).
Enriquez A, Biagi J, Redfearn D, et al. Increased incidence of ventricular arrhythmias in patients with advanced cancer and implantable cardioverter-defibrillators. JACC EP, in press.
certain chemotherapeutic agents and supportive therapy (antiemetic agents, antidepressants) have a propensity to prolong the QT interval, leading to ventricular arrhythmia. The 2016 Canadian Cardiovascular Society guideline supports baseline electrocardiography and periodic monitoring of the QTc interval during cancer treatment in patients receiving QTc-prolonging agents.
direct cardiac involvement by tumor (primary or metastasis), or electrolyte imbalance secondary to vomiting, diarrhea, or decreased oral intake. Further studies are needed to better elucidate the causal relationship between cancer, cancer treatment, and cardiac arrhythmias.
Disclosures
The authors have no conflicts of interest to disclose.
References
Moudgil R.
Yeh E.
Mechanisms of cardiotoxicity of cancer chemotherapeutic agents: cardiomyopathy and beyond.
Enriquez A, Biagi J, Redfearn D, et al. Increased incidence of ventricular arrhythmias in patients with advanced cancer and implantable cardioverter-defibrillators. JACC EP, in press.
Tremendous strides have been made in the treatment of various oncological diseases such that patients are surviving longer and are having better quality of life. However, the success has been tainted by the iatrogenic cardiac toxicities. This is especially concerning in the younger population who are facing cardiac disease such as heart failure in their 30s and 40s as the consequence of the anthracycline’s side effects (used for childhood leukemia and lymphoma). This resulted in the awareness of cardiotoxic effects of anticancer drugs and emergence of a new discipline: oncocardiology.
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