Abstract 17199: A Case of Ventricular Fibrillation Arrest After Immune Checkpoint Inhibitor Therapy

Abstract

Description of Case: Our patient is a 65-year-old male who suffered sudden cardiac arrest due to ventricular fibrillation while receiving his second cycle of therapy for non-small cell lung cancer, which consisted of carboplatin, pemetrexed, nivolumab, and ipilimumab. Initial symptoms included sudden onset chest pain and dyspnea during infusion, which then rapidly progressed to ventricular fibrillation, and he was successfully defibrillated with ROSC. Subsequent coronary angiogram revealed patent coronary arteries, and cardiac MRI (CMR) was consistent with acute myopericarditis. Our patient was treated with high dose steroids and colchicine. Discussion: Immune checkpoint inhibitors (ICI) are a novel drug class with an emerging role in treatment of various tumors, including lung cancer. ICIs prevent the interaction between host checkpoint proteins and tumor partner proteins, allowing the immune system to appropriately attack tumor cells. Two such ICI include nivolumab and ipilimumab, which are frequently administered together. ICI therapy is linked with very rare but potentially life-threatening cardiac side effects including malignant arrhythmias, such as ventricular fibrillation and polymorphic ventricular tachycardia, along with risk of myocarditis and pericarditis. The risk is highest in the first 30 days; patients who received nivolumab and ipilimumab in combination and those treated for non-small cell lung cancer were found to have a higher risk of cardiac side effects. The timeline of events in our patient with subsequent CMR findings make the diagnosis of sudden cardiac arrest secondary to ICI therapy the most likely cause. Patients receiving ICI therapy should be monitored appropriately with algorithms in place for prompt detection and triaging of such patients who develop these side effects.