Influence of high-dose leucovorin and 5-fluorouracil chemotherapy regimen on P wave duration and dispersion

J Clin Pharm Ther. 2004 Jun;29(3):267-71. doi: 10.1111/j.1365-2710.2004.00556.x.

Abstract

Background: Although 5-fluorouracil (5-FU)-related cardiotoxicity is well known, atrial arrhythmia, as a potentially serious complication has not been studied in detail. The aim of this study was to determine the P max and Pd in the electrocardiograms (ECG) of patients receiving 5-FU treatment.

Methods: Twenty-five patients (mean age: 62 years) receiving a 5-FU bolus plus continuous infusion with calcium leucovorin over 48 h and with normal pre-treatment cardiac physical examinations, ECG and echocardiography were enrolled. P maximum (P max), P minimum (P min) and P dispersion (Pd) (maximum minus minimum P wave duration) were measured from the 12-lead ECG at the 0th and 48th hour of the first chemotherapy cycle. Echocardiography was also obtained in all patients at the same times.

Results: Clinical cardiotoxicity was observed in two patients. P max and Pd were both significantly longer after 5-FU treatment at the 48th hour (P < 0.001). P min did not change (P > 0.05).

Conclusion: Treatment with 5-FU based regimens may increase Pd and prolong the P max in cancer patients. These alterations may be predictive of patients at risk of atrial arrhythmias during 5-FU treatment.

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoid Tumor / complications
  • Carcinoid Tumor / diagnosis
  • Carcinoid Tumor / drug therapy
  • Carcinoma / complications
  • Carcinoma / diagnosis
  • Carcinoma / drug therapy
  • Colorectal Neoplasms / complications
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / drug therapy
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / drug therapy
  • Coronary Vasospasm / chemically induced
  • Coronary Vessels / drug effects
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Echocardiography / methods
  • Electrocardiography / drug effects*
  • Electrocardiography / methods
  • Female
  • Fluorouracil / administration & dosage
  • Fluorouracil / adverse effects
  • Fluorouracil / therapeutic use*
  • Humans
  • Infusions, Intravenous
  • Injections, Intravenous
  • Leucovorin / administration & dosage
  • Leucovorin / adverse effects
  • Leucovorin / therapeutic use*
  • Male
  • Stomach Neoplasms / complications
  • Stomach Neoplasms / diagnosis
  • Stomach Neoplasms / drug therapy
  • Time Factors

Substances

  • Leucovorin
  • Fluorouracil