Moriyama Shohei, Yokoyama Taku, Irie Kei, Ito Mamoru, Tsuchihashi Kenji, Fukata Mitsuhiro, Kusaba Hitoshi, Maruyama Toru, Akashi Koichi
Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan.
J Cardiol Cases. 2019 Aug 23;20(5):183-186. doi: 10.1016/j.jccase.2019.08.005. eCollection 2019 Nov.
Fluorouracil (5-FU), a commonly used anticancer agent, has potent cardiotoxicity that is mediated by vascular endothelial injury and vasospasm. Here, we report a patient demonstrating atrial fibrillation (AF), which was most likely induced by vasospasm mediated by 5-FU. A 69-year-old man presented with dysphagia and was diagnosed with advanced esophageal cancer. Frequent paroxysms of atrial fibrillation (AF) were observed during combination chemotherapy including 5-FU. AF was refractory to disopyramide, but was sensitive to antianginal agents (nicorandil and nitroglycerin transdermal patch). Coronary angiography performed within the chemotherapeutic period demonstrated moderate stenosis in the right coronary artery (RCA). Severe spasm at the proximal portion of the atrial branch in RCA was induced by provocation test using acetylcholine. Our case indicated that 5-FU predisposed vasospasm in RCA and the subsequent atrial ischemia may lead to AF. < Fluorouracil (5-FU), a commonly used anticancer agent, induces cardiac ischemic events and sometimes leads to the paroxysms of atrial fibrillation (AF). Coronary-dilating agents should be considered for the treatment of AF which occurs after the administration of 5-FU and is refractory to antiarrhythmic agents.>.
氟尿嘧啶（5-FU）是一种常用的抗癌药物，具有由血管内皮损伤和血管痉挛介导的强效心脏毒性。在此，我们报告一名患者出现心房颤动（AF），极有可能是由5-FU介导的血管痉挛诱发的。一名69岁男性因吞咽困难就诊，被诊断为晚期食管癌。在包括5-FU的联合化疗期间观察到频繁发作的心房颤动（AF）。AF对阵发性室性心动过速无效，但对抗心绞痛药物（尼可地尔和硝酸甘油透皮贴剂）敏感。化疗期间进行的冠状动脉造影显示右冠状动脉（RCA）中度狭窄。使用乙酰胆碱进行激发试验可诱发RCA心房分支近端的严重痉挛。我们的病例表明，5-FU使RCA发生血管痉挛，随后的心房缺血可能导致AF。<氟尿嘧啶（5-FU）是一种常用的抗癌药物，可诱发心脏缺血事件，有时会导致心房颤动（AF）发作。对于5-FU给药后发生且对抗心律失常药物无效的AF，应考虑使用冠状动脉扩张剂进行治疗。>
