International Journal of Cardiology 173 (2014) e40–e41
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Late radiation-induced cardiac conduction system abnormalities G. Trapani a, S. Quartuccio a, A. Dalbeni b, A. Stellitano a, N. Paunovic c, E. Imbalzano a,⁎ a b c
Department of Internal Medicine, Policlinic University of Messina, Italy Department of Internal Medicine, Policlinic University of Verona, Italy Railway Health Care Institute, Belgrade, Serbia
a r t i c l e
i n f o
Article history: Received 2 February 2014 Accepted 14 March 2014 Available online 21 March 2014 Keywords: Cardiac conduction abnormalities Radiation therapy Pacemaker therapy Syncope
We concluded that the diagnosis of high-grade atrioventricular block was linked to the previous radiotherapy. This case focuses on late cardiac complications of radiation therapy and demonstrates that all patients undergoing thoracic irradiation should be followed periodically, to allow for early detection and treatment of cardiac conduction disturbances.
Acknowledgments The authors of this manuscript have certified that they adhere to the statement of ethical publishing as appears in International Journal of Cardiology.
Thoracic radiation remains an effective treatment for breast cancer, but the adverse effects of radiation therapy may include long-term complications [1–3]. Coronary heart disease, pericardial and myocardial disease, injury to cardiac valves, conduction system abnormalities, and other condition diseases are possible late complications of thoracic radiation [4–9]. A 47 year-old female patient was referred to our attention due to recurrent syncope episodes and aggravated shortness of breath for the last month. She had a history of left breast cancer with negative follow-up for many years. Thirteen years earlier, she was treated surgically with partial amputation of the left breast, and subsequently with chemotherapy and radiotherapy of the chest wall at a total dose of 60 Gy. There was no previous other medical history and no family history of any cardiac disease. Baseline electrocardiogram (ECG) showed high-grade atrioventricular (AV) conduction block (Fig. 1), who needed an immediate temporary pacemaker therapy. Blood tests were regular. Echocardiogram showed no abnormalities. After a few days, she was placed on indication for implantable of permanent pacemaker therapy and ECG showed rhythm electro-induced without cardiac AV conduction abnormalities (Fig. 2).
⁎ Corresponding author at: Unità Operativa Complessa di Medicina Interna, Azienda Ospedaliera Universitaria “Policlinico G. Martino”, Via Consolare Valeria n.1, 98125 Messina, Italy. Tel.: +39 3392894665. E-mail address: [email protected] (E. Imbalzano).
http://dx.doi.org/10.1016/j.ijcard.2014.03.125 0167-5273/© 2014 Elsevier Ireland. Ltd. All rights reserved.
References [1] Lancellotti P, Nkomo VT, Badano LP, et al. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging Aug 2013;14(8):721–40. [2] Jaworski C, Mariani JA, Wheeler G, Kaye DM. Cardiac complications of thoracic irradiation. J Am Coll Cardiol Jun 11 2013;61(23):2319–28. [3] Ciabatti N, De Carlo M, Gistri R, Branchitta G, Petronio AS. Aorto-coronary dissection during angioplasty in a patient with history of radiation therapy for breast cancer. Int J Cardiol Apr 12 2007;117(1):e33–4. [4] Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med Mar 14 2013;368(11):987–98. [5] Imbalzano E, Trapani G, Creazzo M, Lizio G, Saitta A. Coronary artery disease in radiotherapy. Int J Cardiol Oct 9 2013;168(4):e125–6. [6] Carpeggiani C, Landi P, Michelassi C, Marraccini P, Picano E. Trends of increasing medical radiation exposure in a population hospitalized for cardiovascular disease (1970–2009). PLoS One 2012;7(11):e50168. [7] Imbalzano E, Dattilo G, Scarpelli M, Lo Gullo A, Saitta A. Left coronary artery fistula to right ventricle complicated heart failure in a patient on hemodialysis. Intern Emerg Med Dec 2013;8(8):765–6. [8] Grillo P, Iannetta L, Missiroli B, et al. Ostial coronary stenoses after radiation therapy. Int J Cardiol Aug 9 2012;159(1):e7–8. [9] Mandraffino G, Dalbeni A, Paunovic N, Mormina EM, Imbalzano E. Radiation-induced heart and vessel atherosclerosis disease. Int J Cardiol 2014;172(2):505–6.
G. Trapani et al. / International Journal of Cardiology 173 (2014) e40–e41
Fig. 1. Baseline electrocardiogram (ECG) showed high-grade atrioventricular conduction block.
Fig. 2. After implantable permanent pacemaker, electrocardiogram showed rhythm electro-induced without atrioventricular conduction abnormalities.
e41
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Late radiation-induced cardiac conduction system abnormalities G. Trapani a, S. Quartuccio a, A. Dalbeni b, A. Stellitano a, N. Paunovic c, E. Imbalzano a,⁎ a b c
Department of Internal Medicine, Policlinic University of Messina, Italy Department of Internal Medicine, Policlinic University of Verona, Italy Railway Health Care Institute, Belgrade, Serbia
a r t i c l e
i n f o
Article history: Received 2 February 2014 Accepted 14 March 2014 Available online 21 March 2014 Keywords: Cardiac conduction abnormalities Radiation therapy Pacemaker therapy Syncope
We concluded that the diagnosis of high-grade atrioventricular block was linked to the previous radiotherapy. This case focuses on late cardiac complications of radiation therapy and demonstrates that all patients undergoing thoracic irradiation should be followed periodically, to allow for early detection and treatment of cardiac conduction disturbances.
Acknowledgments The authors of this manuscript have certified that they adhere to the statement of ethical publishing as appears in International Journal of Cardiology.
Thoracic radiation remains an effective treatment for breast cancer, but the adverse effects of radiation therapy may include long-term complications [1–3]. Coronary heart disease, pericardial and myocardial disease, injury to cardiac valves, conduction system abnormalities, and other condition diseases are possible late complications of thoracic radiation [4–9]. A 47 year-old female patient was referred to our attention due to recurrent syncope episodes and aggravated shortness of breath for the last month. She had a history of left breast cancer with negative follow-up for many years. Thirteen years earlier, she was treated surgically with partial amputation of the left breast, and subsequently with chemotherapy and radiotherapy of the chest wall at a total dose of 60 Gy. There was no previous other medical history and no family history of any cardiac disease. Baseline electrocardiogram (ECG) showed high-grade atrioventricular (AV) conduction block (Fig. 1), who needed an immediate temporary pacemaker therapy. Blood tests were regular. Echocardiogram showed no abnormalities. After a few days, she was placed on indication for implantable of permanent pacemaker therapy and ECG showed rhythm electro-induced without cardiac AV conduction abnormalities (Fig. 2).
⁎ Corresponding author at: Unità Operativa Complessa di Medicina Interna, Azienda Ospedaliera Universitaria “Policlinico G. Martino”, Via Consolare Valeria n.1, 98125 Messina, Italy. Tel.: +39 3392894665. E-mail address: [email protected] (E. Imbalzano).
http://dx.doi.org/10.1016/j.ijcard.2014.03.125 0167-5273/© 2014 Elsevier Ireland. Ltd. All rights reserved.
References [1] Lancellotti P, Nkomo VT, Badano LP, et al. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging Aug 2013;14(8):721–40. [2] Jaworski C, Mariani JA, Wheeler G, Kaye DM. Cardiac complications of thoracic irradiation. J Am Coll Cardiol Jun 11 2013;61(23):2319–28. [3] Ciabatti N, De Carlo M, Gistri R, Branchitta G, Petronio AS. Aorto-coronary dissection during angioplasty in a patient with history of radiation therapy for breast cancer. Int J Cardiol Apr 12 2007;117(1):e33–4. [4] Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med Mar 14 2013;368(11):987–98. [5] Imbalzano E, Trapani G, Creazzo M, Lizio G, Saitta A. Coronary artery disease in radiotherapy. Int J Cardiol Oct 9 2013;168(4):e125–6. [6] Carpeggiani C, Landi P, Michelassi C, Marraccini P, Picano E. Trends of increasing medical radiation exposure in a population hospitalized for cardiovascular disease (1970–2009). PLoS One 2012;7(11):e50168. [7] Imbalzano E, Dattilo G, Scarpelli M, Lo Gullo A, Saitta A. Left coronary artery fistula to right ventricle complicated heart failure in a patient on hemodialysis. Intern Emerg Med Dec 2013;8(8):765–6. [8] Grillo P, Iannetta L, Missiroli B, et al. Ostial coronary stenoses after radiation therapy. Int J Cardiol Aug 9 2012;159(1):e7–8. [9] Mandraffino G, Dalbeni A, Paunovic N, Mormina EM, Imbalzano E. Radiation-induced heart and vessel atherosclerosis disease. Int J Cardiol 2014;172(2):505–6.
G. Trapani et al. / International Journal of Cardiology 173 (2014) e40–e41
Fig. 1. Baseline electrocardiogram (ECG) showed high-grade atrioventricular conduction block.
Fig. 2. After implantable permanent pacemaker, electrocardiogram showed rhythm electro-induced without atrioventricular conduction abnormalities.
e41
