Acute arrhythmogenicity of first-dose chemotherapeutic agents in children.
BACKGROUND
Chemotherapeutic agents have been reported to cause severe arrhythmias and sudden death in the first 24 hr after administration. In this prospective study, we determined the magnitude of acute arrhythmogenicity of those agents in children.


METHODS
Thirty-three patients with diverse malignancies (leukemia n = 16, Wilms tumor n = 3, brain tumor n = 3, lymphoma n = 3, others n = 8) were studied with Holter monitors 24 hr before, during, and in the first 24 hr following the first-dose therapy.


RESULTS
Two patients experienced conduction disturbances (phases of 2nd degree sinuatrial and atrioventricular blocks) during a 4-hr period corresponding to a 30 mg/m(2) daunorubicin infusion. Eight patients experienced supraventricular extrasystole (SE), ventricular extrasystole (VE), and/or short salvos of supraventricular (SVT) and/or ventricular tachycardia (VT). Six had leukemia (therapy: daunorubicin + vincristine), one had a lymphoma (therapy: vincristine + cyclophosphamide), and the last one a brain tumor (therapy: carboplatin + procarbazine). Three patients with leukemia had pretreatment arrhythmias (1 VT, 2 SVT). One of them and the five other patients had arrhythmias during and after the first-dose therapy (2 VE, 2 SVT, 1 SVT + VE, 1 VE + SE + SVT). No patient had life-threatening arrhythmias and no prognostic value of those disturbances could be demonstrated.


CONCLUSIONS
Conduction disturbances and arrhythmias are common in cancer children at the beginning of the therapy, but no acute or long-term adverse consequences are related to their appearance.
Division of Pediatric Cardiology, Department of Pediatrics, University of Liège at C.H.R. Citadelle, Liège, Belgium. martial.massin@chrcitadelle.be
Martial M
MM
Massin
Marie-Françoise
MF
Dresse
Véronique
V
Schmitz
Claire
C
Hoyoux
Jean-Marie
JM
Chantraine
Philippe
P
Lepage
D000208:Acute Disease; D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D011379:Prognosis; D012107:Research Design; D012307:Risk Factors
D000970:Antineoplastic Agents