Atrial Fibrillation Triggered by Paclitaxel Therapy in a Case of Pancreatic Adenocarcinoma

Background: Paclitaxel (PTX), a cornerstone chemotherapeutic agent for solid tumors, is generally well tolerated but has been associated with rare cardiovascular toxicities, including atrial fibrillation (AF).While the reported incidence of PTX-induced AF is only 1.0-1.7%,its occurrence can have significant clinical consequences.Case description: We report the case of a 63-year-old male with pancreatic adenocarcinoma who developed new-onset AF with rapid ventricular response 2 days after initiation of PTX-based chemotherapy.He had no prior cardiac history, and baseline echocardiography demonstrated preserved systolic function.Atrial fibrillation was confirmed on electrocardiography and successfully managed with intravenous amiodarone, metoprolol, magnesium, and prophylactic anticoagulation.The patient reverted to sinus rhythm and was discharged in a stable condition with outpatient cardiology follow-up planned.Discussion: The temporal association between PTX administration and the onset of AF, along with a Naranjo adverse drug reaction probability scale score of +3, categorized PTX as a "possible" cause.However, confounding factors such as advanced malignancy, systemic stress, and vascular access devices were contributory.The exact mechanism of PTX-induced AF remains unclear, but hypotheses include autonomic imbalance, direct myocardial toxicity, and histamine-mediated coronary vasoconstriction.A review of literature suggests that while PTX-related AF is uncommon, chemotherapy-induced arrhythmias represent a clinically important adverse effect requiring vigilant monitoring.Conclusion: This case highlights the importance of early recognition and management of PTX-associated AF, even in patients without preexisting cardiac disease.Clinicians should maintain heightened vigilance during chemotherapy, and further studies are warranted to elucidate mechanisms and guide preventive strategies.