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Blood, 1 March 2001, Vol. 97, No. 5, pp. 1514-1516
BRIEF REPORT
Torsades de pointes in 3 patients with leukemia treated with
arsenic trioxide
Dilip Unnikrishnan,
Janice
P. Dutcher,
Nikita Varshneya,
Richard Lucariello,
Marietta Api,
Susan Garl,
Peter H. Wiernik, and
Salvatore Chiaramida
From the Our Lady of Mercy Cancer Center and Division
of Cardiology, Our Lady of Mercy Medical Center, Bronx, NY, and New
York Medical College, Valhalla, NY.
Arsenic trioxide is used in clinical trials in the
treatment of relapsed and resistant cases of acute
promyelocytic leukemia. Adverse effects from arsenic in these studies
have been multisystemic. Arsenic is known to cause corrected
QT-interval prolongation and T-wave changes, but the
potential for serious ventricular arrhythmias is less well understood.
Torsades de pointes, a form of ventricular tachycardia, has
been reported with arsenic poisoning but not at therapeutic doses used
in protocols for hematologic malignancies. We describe 3 patients in
whom this arrhythmia developed while they were treated with
arsenic trioxide. Early recognition of the arrhythmia or correction of
contributory factors is important because arsenic induced ventricular
arrhythmias are known to be resistant to most chemical methods and
electrical cardioversion.
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Cardiac toxicity of arsenic trioxide
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