Effects of Arsenic Trioxide on Electrocardiography

Liu, Tu-Ying
Luk, Hsiang-Ning
Wang, Tsui-Min
Ding, Philip Yu-An
Chiang, Chern-En

¹Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei;
²Department of Anesthesiology, Chang-Gung Memorial Hospital, Taipei;
³Graduate Institute of Medical Science, Taipei Medical University, Taipei, Taiwan.

Received: August 6, 2002 Accepted: October 15, 2003

Address correspondence and reprint requests to: Dr. Chern-En Chiang, Division of Cardiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan. Tel: 886-2-2875-7602; Fax: 886-2-2874-5422; E-mail: [email protected]

Acta Cardiologica Sinica 20(1):p 1-6, March 2004.

Background:

Arsenic trioxide has recently been found to be very effective for relapsed acute promyelocytic leukemia. Several articles reported prolongation of QT interval or ventricular arrhythmias in patients receiving arsenic trioxide. However, the effects on other electrocardiogram (ECG) have not been determined.

Methods:

Three-channel ECG (leads II, V1 and V5) was recorded from adult Hartley guinea pigs (400–600 gm). The P wave, PR interval and QRS duration were measured at baseline condition just before the administration of various doses (10 mg/Kg, 30 mg/Kg, and 50 mg/Kg) of arsenic trioxide or water (control group) via nasogastric tube, and every 30 minutes until 3 hours. The effect of intravenous arsenic trioxide was also tested. Arsenic trioxide, 0.15 mg/Kg, 0.45 mg/Kg, and 1.5 mg/Kg, were infused for duration of 2 hours. The control group received equivalent volume of saline. The ECG parameters were measured immediately before infusion, at 10 minutes after, and every 30 minutes after infusion for a total of 2 hours.

Results:

Both oral and intravenous arsenic trioxide increased P wave, PR interval and QRS duration in guinea pigs. The percent increase was dose-dependent and time-dependent, and was more prominent in PR interval compared with those in the P wave and QRS duration. There was no change in the control group. Atrioventricular block was observed in high-dose group.

Conclusions:

We have demonstrated that oral and intravenous arsenic trioxide prolonged P wave, PR interval and QRS duration. Routine regular ECG follow-up in patients receiving arsenic trioxide therapy may be indicated, especially in patients who already have prolongation of P wave, PR interval, or bundle branch block, or receiving concomitant administration of sodium channel blockers.