Department of Medical Oncology, Ankara Numune Education and Research Hospital, 06100 Sihhiye, Ankara, Turkey.
Med Oncol. 2013;30(3):609. doi: 10.1007/s12032-013-0609-5. Epub 2013 May 21.
Zoledronic acid (ZA) is one of the important bisphosphonates which is widely used in bone metastatic cancer and osteoporotic patients. In a few studies, it has been reported that treatment with bisphosphonates was associated with an increased risk of atrial fibrillation. We aimed to evaluate the arrhythmias that developed during and immediately after infusion of the ZA. Fifty-two bone metastatic patients were included in the study group. All patients had 24-h Holter monitorization during the first dose ZA infusion day. All of the patients had 4-h basal cardiac rhythm records before ZA infusion and about 19 h after infusion. A short survey including demographic data and past medical history has been completed. None of patients had clinically important arrhythmias before ZA infusion. We divided arrhythmias into two groups as supraventricular and ventricular. We evaluated arrhythmias in pre-infusion, during infusion, and post-infusion periods. ZA was administered 4 mg intravenously (IV) in 15 min. Thirty-three of patients (63.5 %) were male and 19 (36.5 %) patients were female. Mean age of the patients was 53.9 ± 11.8 years. Most frequent cancers were breast (25 %) and lung cancer (15.3 %). Twelve (23 %) patients had history of mediastinal radiotherapy. In basal records, we detected that twenty-four (46 %) of patients had supraventricular premature complexes (SVPC) or ventricular premature complexes (VPC). Fifteen (28.8 %) of patients had SVPC and fourteen (26.9 %) had VPC during infusion period. After infusion period, 48 (92.3 %) of patients had SVPC and 41 (78.8 %) had VPC. Only 3 patients had no arrhythmia after infusion. Three patients had sinus arrhythmia and two had Mobitz type 2 atrioventricular blocks after infusion. One patient, who had no history of comorbidities and had SVPC in the basal records, developed atrial fibrillation that was refractory to medical cardioversion after 10 days of seventh dose of ZA infusion. In this study, we found that both SVPC and VPC increased in cancer patients treated with ZA. Furthermore, ZA may induce clinically important arrhythmias.
唑来膦酸（ZA）是一种重要的双膦酸盐，广泛用于骨转移癌和骨质疏松症患者。有几项研究报告称，使用双膦酸盐治疗与房颤风险增加有关。我们旨在评估 ZA 输注期间和输注后立即发生的心律失常。52 例骨转移患者纳入研究组。所有患者在接受 ZA 首剂量输注的当天进行 24 小时动态心电图监测。所有患者在 ZA 输注前进行 4 小时基础心脏节律记录，并在输注后约 19 小时进行记录。完成了一份包括人口统计学数据和既往病史的简短调查。在接受 ZA 输注之前，没有患者出现临床重要的心律失常。我们将心律失常分为室上性和室性两类。我们在输注前、输注期间和输注后评估心律失常。ZA 以 4 毫克的剂量在 15 分钟内静脉输注。33 例患者（63.5%）为男性，19 例（36.5%）为女性。患者的平均年龄为 53.9±11.8 岁。最常见的癌症是乳腺癌（25%）和肺癌（15.3%）。12 例（23%）患者有纵隔放疗史。在基础记录中，我们发现 24 例（46%）患者存在室上性早搏（SVPC）或室性早搏（VPC）。在输注期间，15 例（28.8%）患者出现 SVPC，14 例（26.9%）患者出现 VPC。输注后，48 例（92.3%）患者出现 SVPC，41 例（78.8%）患者出现 VPC。只有 3 例患者输注后无心律失常。3 例患者输注后出现窦性心律失常，2 例患者出现 Mobitz Ⅱ型房室传导阻滞。一名无合并症病史且在基础记录中存在 SVPC 的患者，在接受 ZA 第 7 剂输注 10 天后出现房颤，且对药物电复律无效。在这项研究中，我们发现接受 ZA 治疗的癌症患者的 SVPC 和 VPC 均增加。此外，ZA 可能引发临床重要的心律失常。
