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A case of ventricular fibrillation as a consequence of capecitabine-induced secondary QT prolongation: A case report.

ABSTRACT: Capecitabine is an oral fluoropyrimidine which can prolong QT interval. However, there have been no reports that capecitabine induced ventricular fibrillation (VF) due to secondary QT prolongation in patients with no structural heart disease. A 39-year-old woman developed VF during the chemotherapy of capecitabine for colon cancer. At the administration, corrected QT interval (QTc) was prolonged to 559 ms despite no evidence of organic heart disease. Discontinuation of capecitabline normalized the QTc (414 ms). During the follow-up of eight years, neither the QTc prolongation nor the recurrent VF has been detected. We report the rare case of capecitabine-related VF without any organic heart disease. <Learning objective: Capecitabine is an oral fluoropyrimidine carbamate commonly used to treat colorectal and breast cancer. Capecitabine has been reported to be associated with VF due to vasospasm. However, capecitabine is also associated with QT elongation. This is the first report to describe VF due to capecitabine-related secondary long QT syndrome in a patient with no cardiac heart disease. Physicians must carefully follow up patients during capecitabine chemotherapy with serial electrocardiograms.>.

SUBMITTER: Hayasaka K

PROVIDER: S-EPMC6149258 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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A case of ventricular fibrillation as a consequence of capecitabine-induced secondary QT prolongation: A case report.

Hayasaka Kazuto K Takigawa Masateru M Takahashi Atsushi A Kuwahara Taishi T Okubo Kenji K Tanaka Yasuaki Y Misawa Toru T Mizusawa Masafumi M Yamakami Yosuke Y Kojima Keisuke K Sagawa Yuichiro Y Hishikari Keiichi K Yamao Kazuya K Nakashima Emiko E Nakajima Jun J Kimura Shigeki S Takagi Katsumasa K Hikita Hiroyuki H Isobe Mitsuaki M

Journal of cardiology cases 20170429 1

Capecitabine is an oral fluoropyrimidine which can prolong QT interval. However, there have been no reports that capecitabine induced ventricular fibrillation (VF) due to secondary QT prolongation in patients with no structural heart disease. A 39-year-old woman developed VF during the chemotherapy of capecitabine for colon cancer. At the administration, corrected QT interval (QTc) was prolonged to 559 ms despite no evidence of organic heart disease. Discontinuation of capecitabline normalized t ...[more]

PMID: 30279790

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Project description:ObjectivesThis study sought to determine whether variations in NOS1AP affect drug-induced long QT syndrome (LQTS).BackgroundUse of antiarrhythmic drugs is limited by the high incidence of serious adverse events including QT prolongation and torsades de pointes. NOS1AP gene variants play a role in modulating QT intervals in healthy subjects and severity of presentation in LQTS.MethodsThis study carried out an association study using 167 single nucleotide polymorphisms (SNP) spanning the NOS1AP gene in 58 Caucasian patients experiencing drug-induced LQTS (dLQTS) and 87 Caucasian controls from the DARE (Drug-Induced Arrhythmia Risk Evaluation) study.ResultsThe rs10800397 SNP was significantly associated with dLQTS (odds ratio [OR]: 3.3, 99.95% confidence interval [CI]: 1.0 to 10.8, p = 3.7 × 10(-4)). The associations were more pronounced in the subgroup of amiodarone users, in which 3 SNPs, including rs10800397, were significantly associated (most significant SNP: rs10919035: OR: 5.5, 99.95% CI: 1.1 to 27.9, p = 3.0 × 10(-4)). We genotyped rs10919035 in an independent replication cohort of 28 amiodarone dLQTS cases versus 173 control subjects (meta-analysis of both studies: OR: 2.81, 99.95% CI: 1.62 to 4.89, p = 2.4 × 10(-4)). Analysis of corrected QT interval among 74 control subjects from our dataset showed a similar pattern of significance over the gene region as the case-control analysis. This pattern was confirmed in 1,480 control subjects from the BRIGHT (British Genetics of Hypertension Study) cohort (top SNP from DARE: rs12734991 in meta-analysis: increase in corrected QT interval per C allele: 9.1 ± 3.2 ms, p = 1.7 × 10(-4)).ConclusionsThese results provide the first demonstration that common variations in the NOS1AP gene are associated with a significant increase in the risk of dLQTS. This study suggests that common variations in the NOS1AP gene may have relevance for future pharmacogenomic applications in clinical practice permitting safer prescription of drugs for vulnerable patients.

Dataset Information

A case of ventricular fibrillation as a consequence of capecitabine-induced secondary QT prolongation: A case report.

Publications

A case of ventricular fibrillation as a consequence of capecitabine-induced secondary QT prolongation: A case report.

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