Chemotherapy-Induced Cardiac Arrhythmias

Introduction to Chemotherapy-Induced Arrhythmias

The European Society of Cardiology recommends that anthracyclines, such as doxorubicin, daunorubicin, and epirubicin, are specifically documented to cause sinus tachycardia 1, 2, 3, 4.
The American College of Cardiology notes that multiple chemotherapy agents, including alkylating agents, anthracyclines, antimetabolites, taxanes, targeted agents, and immunotherapy, can cause supraventricular tachycardias 1, 2, 3, 4.

Alkylating agents, such as cisplatin, cyclophosphamide, ifosfamide, and melphalan, are associated with atrial fibrillation 3.
Anthracyclines, such as doxorubicin, are associated with atrial fibrillation 3.
Antimetabolites, such as capecitabine, 5-fluorouracil, and methotrexate, are associated with supraventricular tachycardias 5.
Taxanes, such as paclitaxel, are associated with ventricular tachycardia 3.
Targeted agents, such as bortezomib, ponatinib, and romidepsin, are associated with ventricular tachycardia 3.
Immunotherapy, such as IL-2 and interferons, is associated with supraventricular tachycardias 3.

The European Heart Journal reports that arrhythmias are present at baseline in 16-36% of treated cancer patients 1, 2, 3, 4.
Patients with cancer who develop atrial fibrillation have significantly increased mortality (OR 1.90; 95% CI 1.65-2.19; P < 0.0001) 5.
The Journal of the American College of Cardiology recommends that proteasome inhibitors, such as bortezomib and carfilzomib, are associated with ventricular tachycardia 6.
The American College of Cardiology suggests that beta-blockers with lower drug interaction potential should be considered for symptomatic tachycardia in hemodynamically stable patients 7.

The European Heart Journal notes that the cancer itself increases arrhythmia risk independent of treatment, with a baseline atrial fibrillation prevalence of 2.4% and an additional 1.8% incidence post-diagnosis 3.
Hematologic malignancies and intrathoracic tumors carry a >2-fold increased risk of arrhythmias 7.
Direct myocardial infiltration can cause both supraventricular and ventricular arrhythmias 5.