Chemotherapy-Induced Arrhythmia Which Was Wide QRS Tachycardia Derived from Supra Vena Cava, Atrial Flutter, and Atrial Fibrillation with Syncope

Abstract

Arrhythmias were reported as a side effect of many chemotherapeutic drugs. Arrhythmias induced by 5-fluorourasil, including ventricular tachycardia, are mostly ischemic in origin and usually occur in the context of coronary spasm produced by this drug. Cisplatin is associated with a very high rate atrial fibrillation. In general, chemotherapy-induced arrhythmia is an existing but poorly recognized and studied entity. A 66-year old male was diagnosed adenocarinoma of the transverse colon (stage IV), and received oxaliplatin (dose 130 mg/m2) and capecitabine (2000 mg/m2). After chemotherapy, the patient developed syncope. The ambulatory electrocardiography data revealed wide QRS tachycardia, but a programmed atrial stimulation induced tachycardia derived from supra vena cava (SVC), atrial fibrillation, and atrial flutter, which was not ventricular tachycardia, were induced by the programmed atrial stimulations in electro physiological study. The patient was performed catheter ablation of cavotricuspid isthmus and SVC isolation without pulmonary vein isolation. After the catheter ablation, tachycardia and syncope was not appeared. We report that chemotherapy induced arrhythmias which was wide QRS tachycardia derived from SVC, atrial flutter, and atrial fibrillation was got well by catheter ablation.