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Cancer Chemotherapy and Cardiac Arrhythmias: A Review

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Abstract

Cardiovascular toxicity is a potential complication of cancer chemotherapy (CC) that increases the morbidity and mortality of cancer patients. Cardiac arrhythmias have been reported as an adverse effect of many chemotherapeutic drugs, including novel targeted therapies. The relationship between chemotherapy and arrhythmias has not been well-established and the proarrhythmogenic mechanisms remain uncertain as they can be the result of a direct electrophysiological effect or of changes in cardiac structure and function, including myocardial ischaemia and heart failure, which create an arrhythmogenic substrate. In this review we summarise available evidence of proarrhythmia induced by CC, discuss the possible mechanisms involved in this adverse effect and emphasise the importance of cardiac monitoring for the early diagnosis, intervention and surveillance of those patients more susceptible to develop proarrhythmia in an attempt to reduce the morbidity and mortality. Oncologists should be fully aware of proarrhythmia and the close collaboration between cardiologists and oncologists would result in a better cardiovascular assessment, risk stratification, cardiac monitoring and treatment during CC and during the follow-up. The final objective is to understand the mechanisms of proarrhythmia and evaluate its real incidence and clinical relevance so as to select the safest and most effective treatment for cancer patients.

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Acknowledgments

We thank Paloma Vaquero for her invaluable technical assistance.

Conflicts of interest

Juan Tamargo, Ricardo Caballero and Eva Delpón have no conflicts of interest that are directly relevant to the content of this review.

Funding

This work was supported by the Instituto de Salud Carlos III (PI11/01030, SAF-2011/30088, SAF-2011/30112, Red HERACLES RD06/0009 and Red Española de Investigación Cardiovascular RD12/0042/0011) and Comunidad Autónoma de Madrid (S2010/BMD-2374).

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  1. Department of Pharmacology, School of Medicine, University Complutense, 28040, Madrid, Spain

    Juan Tamargo, Ricardo Caballero & Eva Delpón

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Correspondence to Juan Tamargo.

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Tamargo, J., Caballero, R. & Delpón, E. Cancer Chemotherapy and Cardiac Arrhythmias: A Review. Drug Saf 38, 129–152 (2015). https://doi.org/10.1007/s40264-014-0258-4

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