Chen Xi, Wang Hui, Zhang Zijin, Xu Yan, An Xuanqi, Ai Xin, Li Lin
Department of Medical Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Front Cardiovasc Med. 2022 Jun 27;9:900406. doi: 10.3389/fcvm.2022.900406. eCollection 2022.
The adverse effects of anticancer therapy in patients with malignancies and cardiovascular diseases are complicated. Oxaliplatin is one of the most commonly used chemotherapy drugs for gastric and colorectal cancers, and oxaliplatin-induced cardiotoxicity has rarely been reported.
We report a 76-year-old man with adenocarcinoma of the esophagogastric junction and a 40-day history of non-ST-elevation myocardial infarction who exhibited a new third-degree atrioventricular block after oxaliplatin administration. We immediately withdrew oxaliplatin treatment and, to avoid future episodes, we implanted a permanent pacemaker for safety and added diltiazem hydrochloride. The third-degree atrioventricular block disappeared after oxaliplatin withdrawal. We detected no recurrence of the third-degree atrioventricular block in future chemotherapies.
This is the first reported oxaliplatin-induced third-degree atrioventricular block, likely mediated by coronary artery spasm. Cancer patients with acute coronary syndrome are a unique and vulnerable population, whom physicians should carefully evaluate and monitor during anticancer treatment. Remarkably, even the most common chemotherapy drugs can cause life-threatening cardiac adverse events.
恶性肿瘤患者和心血管疾病患者接受抗癌治疗的不良反应较为复杂。奥沙利铂是胃癌和结直肠癌最常用的化疗药物之一，奥沙利铂引起的心脏毒性鲜有报道。
我们报告一例76岁食管胃交界腺癌患者，有40天非ST段抬高型心肌梗死病史，在接受奥沙利铂治疗后出现新的三度房室传导阻滞。我们立即停用奥沙利铂治疗，为避免未来发作，植入永久性起搏器以确保安全，并加用盐酸地尔硫䓬。停用奥沙利铂后三度房室传导阻滞消失。在未来化疗中未检测到三度房室传导阻滞复发。
这是首次报道奥沙利铂引起的三度房室传导阻滞，可能由冠状动脉痉挛介导。急性冠状动脉综合征的癌症患者是一个独特且脆弱的群体，医生在抗癌治疗期间应仔细评估和监测。值得注意的是，即使是最常用的化疗药物也可能导致危及生命的心脏不良事件。
