An Unusual Case of Anthracycline-Induced Ventricular Tachycardia in Pregnancy

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Anthracycline-induced nonsustained ventricular tachycardia in pregnancy with invasive ductal breast carcinoma (n=1). Intervention: Metoprolol tartrate. Primary outcome: Recurrence of nonsustained ventricular tachycardia (NSVT) during subsequent doxorubicin cycles.

Michelle J Lew; Najah Khan; Noah Vannarat

doi:10.1016/j.jaccas.2024.102532

September 1, 2024JACC Case ReportsOpen Access

An Unusual Case of Anthracycline-Induced Ventricular Tachycardia in Pregnancy

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Key result

Metoprolol suppresses doxorubicin-induced NSVT in pregnancy, preventing recurrence during subsequent chemotherapy cycles.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Does metoprolol tartrate suppress anthracycline-induced nonsustained ventricular tachycardia and allow safe continuation of doxorubicin chemotherapy in a pregnant patient with metastatic breast cancer?

Key Points

Describe the clinical presentation, evaluation, and pharmacological management of acute nonsustained ventricular tachycardia following initial doxorubicin administration in a pregnant patient.
Clinical evaluation and management of a 34-year-old woman at 18 weeks' gestation who developed dyspnea and palpitations after her first cycle of doxorubicin and cyclophosphamide for metastatic breast carcinoma.
Cardiovascular evaluation utilizing continuous telemetry, 12-lead electrocardiograms, serum troponin I, and transthoracic echocardiography.
Pharmacological intervention using intravenous metoprolol tartrate (5 mg every 4 hours), transitioned and titrated to oral metoprolol tartrate 75 mg three times daily across subsequent chemotherapy rounds.
Initial telemetry and electrocardiogram demonstrated runs of nonsustained ventricular tachycardia with an elevated troponin I of 0.074 ng/mL, despite a preserved left ventricular ejection fraction of 58.6%.
Following titration of metoprolol tartrate, the patient exhibited only 4 beats of nonsustained ventricular tachycardia after her second chemotherapy round and zero further arrhythmias during subsequent cycles.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does metoprolol tartrate suppress anthracycline-induced nonsustained ventricular tachycardia and allow safe continuation of doxorubicin chemotherapy in a pregnant patient with metastatic breast cancer?

P

Population

1 pregnant woman (34 years old, 18 weeks' gestation) with metastatic invasive ductal breast carcinoma presenting with acute doxorubicin-induced nonsustained ventricular tachycardia, followed through delivery at 27 weeks' gestation and discharge on postoperative day 11.

I

Intervention

Metoprolol tartrate 5 mg IV every 4 hours initially, transitioned the next day to 12.5 mg oral every 12 hours, and titrated over 1 week to 75 mg oral 3 times daily, continued during subsequent cycles of intravenous doxorubicin (100 mg) and cyclophosphamide (1,000 mg) every 3 weeks until postoperative day 11 after delivery at gestational week 27.

O

Outcome

Resolution and prevention of recurrent nonsustained ventricular tachycardia (NSVT) on telemetry monitoring during initial admission and subsequent chemotherapy cycles.hard clinical

Acute anthracycline-induced nonsustained ventricular tachycardia during pregnancy can occur after the first dose of doxorubicin and may be effectively managed with metoprolol tartrate without discontinuing chemotherapy.

Limitations

Single-patient case report
Investigation of other etiologies of NSVT (such as cardiac angiogram and other cardiac testing) was limited and deferred due to the patient's gestational status and poor prognosis
Investigation of other etiologies of NSVT (including coronary angiography and additional cardiac testing) was deferred due to the patient's gestational status, normal echocardiogram, and poor prognosis

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Implication

Metoprolol may control doxorubicin-induced NSVT in pregnancy; hypothesis-generating for safe anthracycline continuation.

Abstract

A 34-year-old woman at 18 weeks' gestation experienced shortness of breath and palpitations after receiving her first dose of doxorubicin for right-sided invasive ductal breast carcinoma. Telemetry monitoring found frequent runs of nonsustained ventricular tachycardia that was treated with metoprolol tartrate. No further arrhythmias occurred with subsequent doses of chemotherapy.

Discussion

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Cite This Study

Lew et al. (2024) conducted a case report in Anthracycline-induced nonsustained ventricular tachycardia in pregnancy with invasive ductal breast carcinoma (n=1). Metoprolol tartrate was evaluated on Recurrence of nonsustained ventricular tachycardia (NSVT) during subsequent doxorubicin cycles.

synapsesocial.com/papers/6a7bb7282305edf9bbed1f26 https://doi.org/10.1016/j.jaccas.2024.102532

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An Unusual Case of Anthracycline-Induced Ventricular Tachycardia in Pregnancy

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

An Unusual Case of Anthracycline-Induced Ventricular Tachycardia in Pregnancy

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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