Krebstherapien und Herzrhythmusstörungen – worauf muss ich achten?

Zusammenfassung

Im Rahmen onkologischer Therapien ist das Auftreten von nahezu allen bradykarden und tachykarden Herzrhythmusstörungen beschrieben. Die Arrhythmien können Auswirkungen auf die Krebsbehandlung haben und lebensbedrohliche Ausmaße annehmen. Die Kenntnis des Nebenwirkungsprofils der eingesetzten Substanzklassen ist bedeutsam für das Monitoring der Patienten. Oftmals werden QTc-Zeit-verlängernde Substanzen verabreicht. Eine QTc-Zeit von > 500 ms geht mit einem erhöhten Risiko für ventrikuläre Tachykardien einher und bedarf eines strukturierten Vorgehens gemäß neuer ESC-Leitlinie. Ein Absetzen der lebenswichtigen Krebstherapie sollte der letzte Schritt sein. Die bei Vorhofflimmern etablierten Scoring-Systeme zur Risikostratifizierung sind für Krebspatienten nicht validiert, sodass vor Einleitung einer oralen Antikoagulation eine individuelle Nutzen-Risiko-Abwägung erfolgen sollte.

Abstract

Arrhythmias are common side effects of several major classes of antineoplastic agents. The spectrum of arrhythmias is broad. Arrhythmias can have significant impact on cancer treatment, morbidity, and mortality. Knowledge of the agent-specific cardiovascular side-effects is essential for structured management of cardio-oncologic patients. Several cancer therapies have been recognized to cause QTc prolongation. The risk of malignant arrhythmias is considered to increase with QTc intervals in excess of 500 ms. Careful measurement of the QT interval is important to minimize the risk of arrhythmias and to prevent unnecessary cessation of cancer therapy. The new ESC guideline gives a recommendation for QTc prolongation in cancer patients. The standard risk assessment tools in atrial fibrillation patients have not been validated in the cancer population. Therefore, the decision on anticoagulation should be based on individual risk stratification.

Schlüsselwörter

Krebstherapien - Vorhofflimmern - Arrhythmien - QTc-Zeit-Verlängerung

Keywords

anti-cancer treatment - arrhythmias - QTc interval prolongation - atrial fibrillation

• Literatur

• 1 Zamorano JL, Lancellotti P, Muñoz DR. et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37: 2768-2801
• 2 Lyon AR, López-Fernández T, Couch LS. et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43: 4229-4361
• 3 Tamargo J, Caballero R, Delpón E. et al. Cancer chemotherapy and cardiac arrhythmias: a review. Drug Saf 2015; 38: 129-152
• 4 Svennberg E, Tjong F, Goette A. et al. How to use digital devices to detect and manage arrhythmias: an EHRA practical guide. Europace 2022; 24: 979-1005
• 5 Kilickap S, Barista I, Akgul E. et al. Early and late arrhythmogenic effects of doxorubicin. South Med J 2007; 100: 262-265
• 6 Kuittinen T, Jantunen E, Vanninen E. et al. Cardiac effects within 3 months of BEAC high-dose therapy in non-Hodgkin's lymphoma patients undergoing autologous stem cell transplantation. Eur J Haematol 2006; 77: 120-127
• 7 Feliz V, Saiyad S, Ramarao SM. et al. Melphalan-induced supraventricular tachycardia: incidence and risk factors. Clin Cardiol 2011; 34: 356-359
• 8 Polk A, Vaage-Nilsen M, Vistisen K. et al. Cardiotoxicity in cancer patients treated with 5-fluorouracil or capecitabine: a systematic review of incidence, manifestations and predisposing factors. Cancer Treat Rev 2013; 39: 974-984
• 9 Guglin M, Aljayeh M, Saiyad S. et al. Introducing a new entity: chemotherapy-induced arrhythmia. Europace 2009; 11: 1579-1586
• 10 Shah RR, Morganroth J, Shah RR. et al. Update on Cardiovascular Safety of Tyrosine Kinase Inhibitors: With a Special Focus on QT Interval, Left Ventricular Dysfunction and Overall Risk/Benefit. Drug Saf 2015; 38: 693-710
• 11 Brown JR, Moslehi J, O’Brien S. et al. Characterization of atrial fibrillation adverse events reported in ibrutinib randomized controlled registration trials. Haematologica 2017; 102: 1796-1805
• 12 Steffel J, Collins R, Antz M. et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace 2021; 23: 1612-1676
• 13 Schiattarella GG, Sannino A, Toscano E. et al. Cardiovascular effects of histone deacetylase inhibitors epigenetic therapies: Systematic review of 62 studies and new hypotheses for future research. Int J Cardiol 2016; 219: 396-403
• 14 Amiri-Kordestani L, Moslehi J, Cheng J. et al. Cardiovascular adverse events in immune checkpoint inhibitor trials: A U.S. Food and Drug Administration pooled analysis. J Clin Oncol 2018; 36 (Suppl. 15) 3009
• 15 Bogossian H, Frommeyer G, Ninios I. et al. New formula for evaluation of the QT interval in patients with left bundle branch block. Heart Rhythm 2014; 11: 2273-2277
• 16 Farmakis D, Parissis J, Filippatos G. et al. Insights into Onco-Cardiology. Atrial fibrillation in cancer. J Am Coll Cardiol 2014; 63: 945-953
• 17 Lueck C, Panagiota V, Dammann E. et al. Increased late noncardiac nonrelapse mortality in patients with atrial fibrillation diagnosed during their hospital stay for allogenic stem cell transplantation. Transplant Cell Ther 2022; 28: 609
• 18 Atterman A, Friberg L, Asplund K. et al. Net benefit of oral anticoagulants in patients with atrial fibrillation and active cancer: a nationwide cohort study. Europace 2020; 22: 58-65