Table 1.

Anticancer Agents and Associated Arrhythmias

Anticancer agents	Cancer use	Type of arrhythmia	Frequency	Additional notes
Anthracyclines
Doxorubicin	Breast, sarcoma, lung, bladder, gastric, prostate, leukemia, lymphoma	Sinus tachycardia Premature atrial complexes Premature ventricular complexes QTc prolongation Atrial fibrillation	F	Arrhythmia may be related to cardiotoxicity from anthracyclines rather than direct proarrhythmic drug effects
		Ventricular tachycardia Sinus bradycardia Supraventricular tachycardia Atrioventricular block Bundle-branch block	C
Epirubicin	Breast, esophageal, gastric	Sinus tachycardia Premature atrial complexes Premature ventricular complexes QTc prolongation Atrial fibrillation	F
		Ventricular tachycardia Sinus bradycardia Supraventricular tachycardia Atrioventricular block Bundle-branch block	C
Idarubicin	Acute myeloid leukemia	Sinus tachycardia Premature atrial complexes Premature ventricular complexes QTc prolongation Atrial fibrillation	F
		Ventricular tachycardia Sinus bradycardia Supraventricular tachycardia Atrioventricular block Bundle-branch block	C
Mitoxantrone	Advanced hormone-refractory prostate cancer, nonlymphocytic leukemia	Sinus tachycardia Premature atrial complexes Premature ventricular complexes QTc prolongation Atrial fibrillation	F
		Ventricular tachycardia Sinus bradycardia Supraventricular tachycardia Atrioventricular block Bundle-branch block	C
Antimetabolites
Fluorouracil	Colon, pancreatic, breast, head and	Sinus bradycardia Premature ventricular complexes	F
		Atrial fibrillation Ventricular tachycardia	C
Capecitabine	Breast, colon, gastric, pancreatic	Sinus tachycardia	F
		Atrial fibrillation Sinus bradycardia Premature atrial complexes Premature ventricular complexes QTc prolongation	C
Fludarabine	Lymphoma, leukemia, stem cell transplant	Supraventricular tachycardia	C
Gemcitabine	Small cell lung, non–small cell lung, metastatic breast lymphomas	Atrial fibrillation Atrial flutter	C	Arrhythmia is seen most frequently when gemcitabine is used in combination with vinorelbine
		Ventricular tachycardia	R
Alkylating agents
Cyclophosphamide	Breast, lymphoma, myeloma, sarcoma, stem cell transplant	Sinus tachycardia	F	Similar to anthracyclines, some of the proarrhythmic effects may be related to associated cardiotoxicity from cyclophosphamide
		Premature atrial complexes Supraventricular tachycardia Atrial fibrillation Premature ventricular complexes	C
		Ventricular tachycardia	R
Melphalan	Multiple myeloma, ovarian, neuroblastoma, stem cell transplant	Atrial fibrillation	F
		Supraventricular tachycardia	C
		Premature ventricular complexes Ventricular tachycardia	R
Platinum-based drugs
Cisplatin	Lung, bladder, testicular, breast, esophageal, head and neck	Ventricular tachycardia Supraventricular tachycardia	C	Rates of supraventricular tachycardia and atrial fibrillation are significantly higher with infusions into the intrapericardial space or other serous cavities
		Atrial fibrillation Bradycardia Atrioventricular block	R
Immunomodulatory drugs
Lenalidomide	Myelodysplastic syndrome, multiple myeloma, mantle cell lymphoma	Atrial fibrillation	C	Reported rates of atrial fibrillation are from patients with multiple myeloma; risk may be driven by underlying disease with AL amyloid in a proportion of the cohort
		Ventricular tachycardia	R
Thalidomide	Multiple myeloma	Atrial fibrillation	R
		Premature ventricular complexes Ventricular tachycardia	R
Proteasome Inhibitors
Carfilzomib	Multiple myeloma	Atrial fibrillation	R
Small-molecule tyrosine kinase inhibitors
Ibrutinib	Chronic lymphocytic leukemia, small lymphocytic lymphoma, mantle cell lymphoma, Waldenstrom macroglobulinemia, chronic graft-versus-host disease	Atrial fibrillation Atrial flutter	C	Newer-generation Bruton tyrosine kinase inhibitors have shown lower rates for arrhythmias (eg, acalabrutinib)
		Ventricular tachycardia Premature ventricular complexes	R
Vemurafenib	Melanoma	QTc prolongation	F
		Atrial fibrillation	C
		Ventricular arrhythmia Supraventricular tachycardia Torsades de pointes Premature ventricular complexes Sinus bradycardia Sinus tachycardia	R
Chimeric antigen receptor T-cell therapy
Tisagenlecleucel Axicabtagene ciloleucel	B-cell acute lymphoblastic leukemia (refractory or relapse) Large B-cell lymphoma (refractory or relapse)	Atrial fibrillation Supraventricular tachycardia	C
Histone deacetylase inhibitors
Romidepsin	Cutaneous T-cell lymphoma	QTc prolongation Supraventricular tachycardia	C
		Atrial fibrillation Torsades de pointes Ventricular tachycardia	R
Panobinostat	Multiple myeloma	QTc prolongation	C
		Premature ventricular complexes Ventricular tachycardia	R
Vorinostat	Cutaneous T-cell lymphoma	QTc prolongation	C
		Premature ventricular complexes	R
Immune checkpoint inhibitors
Nivolumab Ipilimumab Pembrolizumab	Melanoma, lung, kidney, bladder, head and neck, lymphoma	Atrial fibrillation Sinus Bradycardia Atrioventricular block QTc prolongation Ventricular tachycardia Ventricular fibrillation	R	Risk for arrhythmia may be associated with development of myocarditis
Antimicrotubule agents
Docetaxel	Breast, lung, prostate, gastric, head and neck	Sinus tachycardia Atrial flutter	R
Paclitaxel	Breast, ovarian, lung, sarcoma, bladder, cervical, gastric, esophageal, head and neck	Sinus tachycardia Sinus bradycardia	F
		Atrioventricular block Atrial fibrillation Supraventricular tachycardia Atrioventricular block Ventricular tachycardia Premature ventricular complexes	R

The frequency of toxicity was graded as rare (R) <1% incidence, common (C) 1% to 10% incidence, or frequent (F) >10% incidence in clinical trials or observational studies.