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Chapter 42 - Palpitations

Published online by Cambridge University Press:  24 April 2026

By
Bradley R. Owens  and
Moira Davenport
Edited by
Angela Bray Lindsay  and
Monica Kathleen Wattana
Angela Bray Lindsay
Affiliation:
Virginia Commonwealth University
Monica Kathleen Wattana
Affiliation:
University of Texas, MD Anderson Cancer Center
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Summary

1. Patients should be screened for potential risk factors of cardiac toxicity and should receive care from a cardiologist, ideally one specializing in oncology. Dose adjustments, active cardiac surveillance, awareness of potential effects, and expert consultation early in the management of cancer are all effective measures for prevention of cancer treatment induced cardiac side effects.

2. Patients with diagnosed dysrhythmias may require prolonged monitoring with ambulatory recorders and possibly oncology specific cardiology follow up.

3. Standard therapy should be used to initially treat chemotherapy-associated ventricular dysrhythmia. Mexiletine may be the preferred antidysrhythmic due to dosing and mechanism.

4. Some dysrhythmias may abate after withdrawal of offending agent, but some dysrhythmias may be permanent and necessitate AICD placement

5. For patients who are administered IV fluid hydration, choice of fluids should be based on the risk associated with increased electrolyte content of non-isotonic solutions.

Keywords

Immunomodulatorschemotherapycardiac dysrhythmiascardiotoxicityatrial fibrillationEKG changestumor lysis syndromebradycardiaradiation therapycomplications of chemotherapy

Information

Type
Chapter
Information
Oncologic Emergency Medicine
Clinical Cases Illustrating Key Concepts
 , pp. 221 - 228
Publisher: Cambridge University Press
Print publication year: 2026

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References

Further Reading

Agarwal, MA, Sridharan, A, Pimentel, RC, Markowitz, SM, Rosenfeld, LE, Fradley, MG, et al. Ventricular arrhythmia in cancer patients: mechanisms, treatment strategies and future avenues. Arrhythm Electrophysiol Rev. 2023;12:e16. Published 2023 May 29. doi:10.15420/aer.2023.04CrossRefGoogle ScholarPubMed
Barber, M, Nguyen, LS, Wassermann, J, Spano, JP, Funck-Brentano, C, Salem, JE. Cardiac arrhythmia considerations of hormone cancer therapies. Cardiovasc Res. 2019;115(5):878–894. doi:10.1093/cvr/cvz020CrossRefGoogle ScholarPubMed
Buza, V, Rajagopalan, B, Curtis, AB. Cancer treatment-induced arrhythmias: focus on chemotherapy and targeted therapies. Circ Arrhythm Electrophysiol. 2017;10(8):e005443. doi:10.1161/CIRCEP.117.005443CrossRefGoogle ScholarPubMed
Chandrasekhar, S, Fradley, MG. QT interval prolongation associated with cytotoxic and targeted cancer therapeutics. Curr Treat Options Oncol. 2019;20(7):55. Published 2019 May 25. doi:10.1007/s11864-019-0657-yCrossRefGoogle ScholarPubMed
Essa, H, Wright, DJ, Dobson, R, Lip, GYH. Chemotherapy-induced arrhythmia: underrecognized and undertreated. Am J Med. 2021;134(10):1224–1231.e1. doi:10.1016/j.amjmed.2021.05.026CrossRefGoogle ScholarPubMed
Guglin, M, Aljayeh, M, Saiyad, S, Ali, R, Curtis, AB. Introducing a new entity: chemotherapy-induced arrhythmia. Europace. 2009;11(12):1579–1586. doi:10.1093/europace/eup300CrossRefGoogle ScholarPubMed
Herrmann, J. Adverse cardiac effects of cancer therapies: cardiotoxicity and arrhythmia. Nat Rev Cardiol. 2020;17(8):474–502. doi:10.1038/s41569-020-0348-1CrossRefGoogle ScholarPubMed
Joseph, L, Nickel, C Patel, A Saba, A Leon, NF El-Chami, AR MF, et al. Incidence of cancer treatment induced arrhythmia associated with immune checkpoint inhibitors. J Atr Fibrillation. 2021;13(5):2461. Published 2021 Feb 28. doi:10.4022/jafib.2461Google ScholarPubMed
Joshi, AM, Prousi, GS, Bianco, C, Malla, M, Guha, A, Shah, M, et al. Microtubule Inhibitors and Cardiotoxicity. Curr Oncol Rep. 2021;23(3):30. Published 2021 Feb 13. doi:10.1007/s11912-021-01014-0CrossRefGoogle ScholarPubMed
Leiva, O, Bohart, I, Ahuja, T, Park, D. Off-target effects of cancer therapy on development of therapy-induced arrhythmia: a review. Cardiology. 2023;148(4):324–334. doi:10.1159/000529260CrossRefGoogle ScholarPubMed
Sharalaya, Z, Collier, P. Prevention of cardiotoxicities with traditional and novel chemotherapeutic agents. Curr Heart Fail Rep. 2018;15(4):260–269. doi:10.1007/s11897-018-0400-1CrossRefGoogle ScholarPubMed
www.uptodate.com/contents/tumor-lysis-syndrome-pathogenesis-clinical-manifestations-definition-etiology-and-risk-factors?search=tumor%20lysis%20syndrome&source=search_result&selectedTitle=2%7E101&usage_type=default&display_rank=2 retrieved March 21, 2024.Google Scholar
www.uptodate.com/contents/initial-treatment-of-stage-ii-to-iv-follicular-lymphoma?search=follicular%20lymphoma&source=search_result&selectedTitle=2%7E150&usage_type=default&display_rank=2#H3885731830 retrieved May 19, 2024.Google Scholar
www.uptodate.com/contents/treatment-protocols-for-breast-cancer?search=breast%20cancer%20therapy&source=search_result&selectedTitle=2%7E150&usage_type=default&display_rank=2 retrieved March 12, 2024.Google Scholar

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