Original Article

Early and Late Arrhythmogenic Effects of Doxorubicin

Authors: Saadettin Kilickap, MD, Ibrahim Barista, MD, Ebru Akgul, MD, Kudret Aytemir, MD, Sercan Aksoy, MD, Gulten Tekuzman, MD


Background: To determine the incidence of early and late arrhythmogenic effects of doxorubicin-containing chemotherapy regimens.

Patients and Methods: A prospective study including 29 patients who were treated with doxorubicin-containing regimens. Cardiac evaluation was based on 24-hour electrocardiographic monitorization (Holter), which was performed during the first cycle of doxorubicin-containing regimens, as well as after the last cycle of chemotherapy.

Results: The mean age of the patients was 45.8 ± 15.1 (range 18–69). Holter records obtained during the first cycle of treatment revealed varying arrhythmias in 19 patients (65.5%) and in 18 (62.1%) patients after completion of therapy. One patient presented with syncope and both Mobitz Type 2 atrioventricular block and complete atrioventricular block were demonstrated. The patient subsequently underwent permanent pacemaker implantation.

Conclusions: Doxorubicin may result in arrhythmias both in early and late periods of treatment. These arrhythmias are rarely life threatening.

Key Points

* Cardiotoxicity is a well-known side effect of doxorubicin, a chemotherapeutic agent used in cancer treatment, and is frequently a dose-limiting factor.

* Doxorubicin-induced arrhythmia may be ventricular or supraventricular and can even present as a nonspecific electrocardiographic abnormality. Life-threatening arrhythmias rarely develop.

* In this study, we investigated doxorubicin-related arrhythmias, both in the early and late periods. Rhythm abnormalities recorded in both periods were similar, with the most common arrhythmia being supraventricular extrasystole.

* Doxorubicin is a cardiotoxic agent that can cause rhythm disturbances during or after its infusion and should be used with great caution.

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