title: Gemcitabine and atrial fibrillation: a rare manifestation of chemotherapy toxicity.
abstract: Gemcitabine is a purine analog with known activity in many solid tumors, namely lung, breast, pancreatic, genitourinary and head/neck cancers. Cardiac toxicity is a rare event and only one report previously described atrial fibrillation (AF) as a consequence of gemcitabine infusion. We report two cases of women suffering from lung cancer who were treated with gemcitabine. Both patients were admitted to hospital for paroxysmal AF occurring 12-24 h after the infusion of the drug. In the first case a sinus rhythm was spontaneously repristinated when AF occurred for the first time, while the second episode required an anti-arrhythmic drug to interrupt the dysrhythmia. In the second case, the patient had to be treated with digitalis glycoside to control the ventricular response without attaining a sinus rhythm. We could not recognize any other precipitating factor beyond the infusion of gemcitabine as a cause for the arrhythmia. Both cases were treated with gemcitabine for lung cancer and we observed the appearance of AF less than 24 h after drug administration. We assume that 2',2'-difluorodeoxyuridine, an active metabolite of gemcitabine, could be responsible for the toxic effect. We conclude that AF is an unusual, but potentially dangerous, side-effect of gemcitabine infusion. The arrhythmia should be suspected whenever patients complain of dyspnea and palpitations beginning 12-24 h after treatment. In these cases, the treatment of AF consists of anti-arrhythmic drugs in order to repristinate a sinus rhythm or control the heart rate.
authors.affiliation: Division of Medical Oncology, San Paolo University Hospital, Milan, Italy. daris.ferrari@ao-sanpaolo.it
authors.forename: Daris
authors.initials: D
authors.lastname: Ferrari
authors.forename: Claudia
authors.initials: C
authors.lastname: Carbone
authors.forename: Carla
authors.initials: C
authors.lastname: Codecà
authors.forename: Luca
authors.initials: L
authors.lastname: Fumagalli
authors.forename: Laura
authors.initials: L
authors.lastname: Gilardi
authors.forename: Desiré
authors.initials: D
authors.lastname: Marussi
authors.forename: Tiziana
authors.initials: T
authors.lastname: Tartaro
authors.forename: Sabina
authors.initials: S
authors.lastname: Oldani
authors.forename: Francesca
authors.initials: F
authors.lastname: Zannier
authors.forename: Paolo
authors.initials: P
authors.lastname: Foa
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000139:chemically induced*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D000093542:Gemcitabine