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Cancer Chemotherapy-Induced Sinus Bradycardia: A Narrative Review of a Forgotten Adverse Effect of Cardiotoxicity

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Abstract

Cardiotoxicity is a common adverse effect of anticancer drugs (ACDs), including the so-called targeted drugs, and increases morbidity and mortality in patients with cancer. Attention has focused mainly on ACD-induced heart failure, myocardial ischemia, hypertension, thromboembolism, QT prolongation, and tachyarrhythmias. Yet, although an increasing number of ACDs can produce sinus bradycardia (SB), this proarrhythmic effect remains an underappreciated complication, probably because of its low incidence and severity since most patients are asymptomatic. However, SB merits our interest because its incidence increases with the aging of the population and cancer is an age-related disease and because SB represents a risk factor for QT prolongation. Indeed, several ACDs that produce SB also prolong the QT interval. We reviewed published reports on ACD-induced SB from January 1971 to November 2020 using the PubMed and EMBASE databases. Published reports from clinical trials, case reports, and recent reviews were considered. This review describes the associations between ACDs and SB, their clinical relevance, risk factors, and possible mechanisms of onset and treatment.

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The authors thank P Vaquero for her invaluable technical assistance.

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  1. Department of Pharmacology, School of Medicine, Universidad Complutense, Institute of Health Gregorio Marañón, CIBERCV, 28040, Madrid, Spain

    Juan Tamargo, Ricardo Caballero & Eva Delpón

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Correspondence to Juan Tamargo.

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This work was supported by grants from the Ministerio de Ciencia e Innovación (SAF2017-88116-P), Instituto de Salud Carlos III (CIBER-Cardiovascular [CB16/11/00303]), and Comunidad de Madrid (B2017/BMD-3738).

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Juan Tamargo, Ricardo Caballero, and Eva Delpón have no conflicts of interest that are directly relevant to the content of this article.

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Initial idea and overall supervision: JT. Related search: JT, RC, ED. Data collection: JT, RC, ED. There were no disagreements between authors, and all authors read and approved the final version.

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Tamargo, J., Caballero, R. & Delpón, E. Cancer Chemotherapy-Induced Sinus Bradycardia: A Narrative Review of a Forgotten Adverse Effect of Cardiotoxicity. Drug Saf 45, 101–126 (2022). https://doi.org/10.1007/s40264-021-01132-5

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