Cardiac arrhythmias after cisplatin infusion: Three case reports and a review of the literature

Abstract

Several antineoplastic drugs are known to have cardiactoxic effects [1-4] which may be dose-limiting, and whichrange over a wide spectrum of cardiac pathology, in-cluding cardiomyopathy, ischaemia and arrhythmia [1].Supraventricular and ventricular arrhythmias often oc-cur suddenly and unexpectedly, and are sometimes life-threatening. Their pathogenesis is often ascribed todirect drug-induced myocardial toxicity, but indirectmechanisms due to electrolyte imbalances may also beinvolved [1, 2, 4].Cisplatin is widely used in the treatment of many neo-plastic diseases. Its major side effects include nephrotox-icity, myelotoxicity, ototoxicity, neurotoxicity and gastro-intestinal toxicity [5], but changes in intracellular andextracellular magnesium (Mg) concentrations are alsofrequently reported [6-10]. Conversely, cardiac toxicityis only occasionally observed [11-13], and is commonlyconsidered to be a consequence of direct cisplatin-induced myocardial toxicity [11]. In this paper, we reportthree cases of supraventricular tachyarrhythmia, in whichcisplatin-induced changes in Mg homeostasis may havebeen implicated.CaselIn September 1995, a 68-year-old man was admitted toour department for treatment of a stage HI B non-small-cell lung cancer (NSCLC), without evidence of pericar-dial involvement on computed tomography (CT). Hehad no history of cardiac disease, and his arterial bloodpressure, and basal electrocardiogram (ECG) and echo-cardiography results were normal. Chemotherapy wasstarted with intravenous (i.v.) cisplatin 100 mg/m