title: [Adams-Stokes attack due to complete atrioventricular block in a patient with acute promyelocytic leukemia during remission induction therapy using all-trans retinoic acid].
abstract: We describe a case of Adams-Stokes syncope due to complete atrioventricular block which occurred in a leukemic patient receiving all-trans retinoic acid (ATRA). Remission induction therapy was performed for a 46-year-old Japanese man with acute promyelocytic leukemia using ATRA (45 mg/m2), enocitabine (170 mg/m2, 5 days), and mitoxantrone (4 mg/m2, 3 days). On the 25th day of chemotherapy, syncope suddenly occurred. Electrocardiography revealed a complete atrioventricular block, and a temporary pacemaker was inserted on the following day. The block was persistent and the cardiac rhythm was dependent on the pacemaker. ATRA was discontinued on the 29th day because the arrhythmia was believed to be an adverse reaction to the ATRA regimen. The normal sinus rhythm was restored 15 days thereafter, and the patient eventually reached remission. He subsequently received 4 courses of consolidation therapy without any cardiovascular complications. Although ATRA sometimes induces arrhythmias, to the best of our knowledge this is the first report in the literature of such a critical ATRA-related arrhythmia.
authors.affiliation: First Department of Internal Medicine, University of Fukui.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Hajime
authors.initials: H
authors.lastname: Arai
authors.forename: Masahiro
authors.initials: M
authors.lastname: Taga
authors.forename: Naoki
authors.initials: N
authors.lastname: Amaya
authors.forename: Jong-Dae
authors.initials: JD
authors.lastname: Lee
authors.forename: Takanori
authors.initials: T
authors.lastname: Ueda
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003561:Cytarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D006327:Heart Block / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D010138:Pacemaker, Artificial; D012074:Remission Induction; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D003561:Cytarabine; D014212:Tretinoin; C015019:enocitabine; D008942:Mitoxantrone