Atrial flutter associated with carboplatin administration.
OBJECTIVE
To report a novel case of atrial flutter associated with carboplatin administration and review chemotherapy-related cardiac toxicities, focusing on platinum-containing compounds.


METHODS
A 69-year-old man with extensive small cell lung cancer and asymptomatic cardiovascular and cerebrovascular disease was inconsistently adherent to his medication regimen. While undergoing carboplatin infusion, he developed atrial flutter. He had no other immediate arrhythmogenic causes of atrial flutter and the arrhythmia spontaneously reverted to sinus rhythm after 24 hours. His condition remained stable until he died 8 days later. The cause of death was unknown and the family declined postmortem examination.


CONCLUSIONS
Although this patient's cardiac history and nonadherence to his medications may have increased his susceptibility to develop atrial arrhythmias, the Naranjo probability scale reveals a possible relationship between atrial flutter and infusion of carboplatin. A literature search revealed other adverse cardiac events due to platinum compounds; however, to our knowledge, this case is the first to describe an association with atrial flutter. A definitive causal link cannot be determined, but this may have been the result of a direct arrhythmogenic effect of treatment or to a novel hypersensitivity reaction. Given the potential deleterious impact of drug-induced arrhythmias, we have reported this case to the Food and Drug Administration as a new adverse effect of carboplatin.


CONCLUSIONS
Providers should consider cardiac monitoring during carboplatin infusion in patients with known cardiac disease or at high risk of cardiac complications.
Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA. szakari2@jhmi.edu
Sammy
S
Zakaria
Kit Yu
KY
Lu
Veronique
V
Nussenblatt
Ilene
I
Browner
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001282:Atrial Flutter / Q000139:chemically induced*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy; D008297:Male; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy
D000970:Antineoplastic Agents; D016190:Carboplatin