Sinus node dysfunction as a late complication of Hodgkin lymphoma treatment
, 1, 2, 1
Abstract
Cardiotoxicity and cardiovascular complications associated with radiation therapy can be revealed many years after oncological therapy, most often 15-20 years after this treatment. A 45-year-old man was admitted to hospital due to syncope with accompanying head injury. At the age of 30, he was diagnosed with Hodgkin lymphoma (clinical stage III) and underwent chemotherapy (including doxorubicin), followed by thoracic radiotherapy. Complete remission of the disease was achieved and the patient remained under constant hematological control for the following years. On admission to the hospital, sinus bradycardia up to 25 bpm was recorded in electrocardiographic (ECG) examination, without other abnormalities. ECG monitoring carried out in the following hours revealed episodes of sinus arrest (up to 17 seconds). Laboratory test results were in the normal range. Transthoracic echocardiography showed no abnormalities. Oncological treatment has been considered the most likely cause of sinus node damage. Due to symptomatic sinus node dysfunction, the patient was implanted with a dual chamber pacemaker. The presented case report confirms the need for indefinite cardiological supervision in patients after oncological treatment in childhood or youth, especially when thorax irradiation and chemotherapy with proven cardiotoxicity were required.
Keywords: Hodgkin lymphomasinus node dysfunctionradiotherapycardiotoxicityoncological treatmentcardiooncology
References
- Curigliano G, Lenihan D, Fradley M, et al. ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol. 2020; 31(2): 171–190.
- Zamorano JL, Lancellotti P, et al. Rodriguez Muñoz D, 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur J Heart Fail. 2016; 37: 2768–801.
- Adams MJ, Lipsitz SR, Colan SD, et al. Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy. J Clin Oncol. 2004; 22(15): 3139–3148.
- Donnellan E, Phelan D, McCarthy CP, et al. Radiation-induced heart disease: A practical guide to diagnosis and management. Cleve Clin J Med. 2016; 83(12): 914–922.
- Wang H, Wei J, Zheng Q, et al. Radiation-induced heart disease: a review of classification, mechanism and prevention. Int J Biol Sci. 2019; 15(10): 2128–2138.
- Galper SL, Yu JB, Mauch PM, et al. Clinically significant cardiac disease in patients with Hodgkin lymphoma treated with mediastinal irradiation. Blood. 2011; 117(2): 412–418.
- Nabiałek-Trojanowska I, Lewicka E, Wrona A, et al. Cardiovascular complications after radiotherapy. Cardiol J. 2018 [Epub ahead of print].
- Armenian SH, Lacchetti C, Lenihan D, et al. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017; 35(8): 893–911.
- Lancellotti P, Nkomo VT, Badano LP, et al. European Society of Cardiology Working Groups on Nuclear Cardiology and Cardiac Computed Tomography and Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography. 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. J Am Soc Echocardiogr. 2013; 26(9): 1013–1032.
