Key result
Intravenous ibutilide triggers torsades de pointes and marked QTc prolongation during concurrent osimertinib therapy.
Why the study?
Osimertinib is the standard first-line therapy for advanced EGFR-mutant NSCLC, but it carries potential proarrhythmic effects including QT prolongation and AF.
Case Report (n=1)
No
Concomitant use of intravenous ibutilide for atrial fibrillation cardioversion in a patient taking long-term osimertinib following pulsed field ablation can precipitate life-threatening torsades de pointes, warranting extreme caution and close ECG monitoring.
Answers are grounded in this paper and cite their sources.
May indicate torsades risk with ibutilide plus osimertinib; leaves open broader applicability pending prospective study.
Osimertinib, a third-generation EGFR-TKI, is the standard of care in first-line therapy for advanced EGFR-mutant non-small cell lung cancer (NSCLC), but with the potential proarrhythmic effects including QT prolongation and atrial fibrillation (AF). We report a 77-year-old woman on long-term osimertinib for non-small cell lung cancer who developed early recurrent AF on postoperative day 1 following pulsed field ablation (PFA). Intravenous ibutilide was administered for cardioversion, during which she developed torsades de pointes (TdP) with transient loss of consciousness that resolved spontaneously after drug discontinuation and electrolyte supplementation. This case highlights the proarrhythmic risk when ibutilide is used in patients receiving osimertinib, particularly in the setting of recent ablation and early post-procedural rhythm instability. Caution is warranted with QT-prolonging agents in this population, and close ECG monitoring is essential.
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Jiao et al. (2026) conducted a case report in Early recurrent atrial fibrillation following pulsed field ablation in a patient on long-term osimertinib for non-small cell lung cancer (n=1). Intravenous ibutilide co-administered with long-term osimertinib was evaluated on Torsades de pointes and QTc prolongation. Intravenous ibutilide induced torsades de pointes and a QTc of 485 ms in a 77-year-old woman on osimertinib daily after pulsed field ablation, resolving 30 minutes after drug cessation.
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