Cyclophosphamide/epirubicin/paclitaxel

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Heart block: case report A 47-year-old woman developed heart block after treatment with cyclophosphamide, epirubicin and paclitaxel. The woman was diagnosed with breast cancer and started receiving neo-adjuvant chemotherapy with paclitaxel [Taxol], cyclophosphamide and epirubicin [treatment durations and dosages not stated]. Six months postdiagnosis, she was scheduled to undergo left mastectomy and latissimus dorsi flap reconstruction. On examination preoperatively, she was found to have a HR of 45 beats/min, and ECG demonstrated bradycardia with Mobitz type II second degree heart block (2:1 block). Six days later, the woman was admitted and she underwent insertion of a temporary ventricular pacing wire through a right jugular vein introducer, with no complications. The unit was set to 40 beats/min overnight and, the following day, mastectomy and reconstruction were performed; before anaesthesia induction, her cardiac rhythm was second degree heart block with regular ventricular bigeminy and, on induction, her pacemaker was set to 80 beats/min. The surgery was uneventful and, due to her haemodynamic stability, her pacemaker was returned to the same settings as before surgery. There were future plans to insert a permanent pacemaker. Author comment: "Cyclophosphamide can also cause an acute coronary syndrome during administration that can in rare cases last up to 1 week, but it seldom causes permanent damage to the heart. Combining treatments may also increase the risk of cardiotoxicity: there is evidence that pharmacokinetic interactions between taxanes and anthracyclines may cause toxic metabolites to accumulate." Wheeler DW, et al. Peri-operative atrioventricular block as a result of chemotherapy with epirubicin and paclitaxel. Anaesthesia 62: 186-189, No. 2, Feb 801063710 2007 - England

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Reactions 3 Mar 2007 No. 1141

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