Cancer Chemotherapy and Cardiac Arrhythmias: A Review

• Published in: Drug safety Vol. 38; no. 2; pp. 129 - 152
• Main Authors: Tamargo, Juan, Caballero, Ricardo, Delpón, Eva
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2015; Springer Nature B.V
• Subjects: Animals; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antineoplastic Agents - pharmacology; Antineoplastic Agents - therapeutic use; Arrhythmias, Cardiac - chemically induced; Arrhythmias, Cardiac - complications; Arrhythmias, Cardiac - diagnosis; Cancer; Cancer therapies; Cardiac arrhythmia; Cardiology; Cardiotoxicity; Cardiovascular disease; Chemotherapy; Coronary vessels; Drug dosages; Drug Safety and Pharmacovigilance; Electrocardiography; Heart Conduction System - drug effects; Heart failure; Humans; Kidney diseases; Medicine; Medicine & Public Health; Mortality; Neoplasms - complications; Neoplasms - drug therapy; Pharmacology/Toxicology; Review Article; Risk Factors; Sunitinib; Bortezomib; Atrial Fibrillation; Sorafenib; Ventricular Tachycardia
• ISSN: 0114-5916; 1179-1942
• DOI: 10.1007/s40264-014-0258-4

Cardiovascular toxicity is a potential complication of cancer chemotherapy (CC) that increases the morbidity and mortality of cancer patients. Cardiac arrhythmias have been reported as an adverse effect of many chemotherapeutic drugs, including novel targeted therapies. The relationship between chemotherapy and arrhythmias has not been well-established and the proarrhythmogenic mechanisms remain uncertain as they can be the result of a direct electrophysiological effect or of changes in cardiac structure and function, including myocardial ischaemia and heart failure, which create an arrhythmogenic substrate. In this review we summarise available evidence of proarrhythmia induced by CC, discuss the possible mechanisms involved in this adverse effect and emphasise the importance of cardiac monitoring for the early diagnosis, intervention and surveillance of those patients more susceptible to develop proarrhythmia in an attempt to reduce the morbidity and mortality. Oncologists should be fully aware of proarrhythmia and the close collaboration between cardiologists and oncologists would result in a better cardiovascular assessment, risk stratification, cardiac monitoring and treatment during CC and during the follow-up. The final objective is to understand the mechanisms of proarrhythmia and evaluate its real incidence and clinical relevance so as to select the safest and most effective treatment for cancer patients.