Electrochemotherapy and heart function:Treatment in a patient with implantable cardioverter defibrillator/pacemaker

作     者：Maurizio Marandola Alida Albante Raffaele Quaglione Claudia Lucci Matteo Chiaretti Luigi Tritapepe 

作者机构：Department of CardiovascularRespiratoryNephrologicAnesthesiologic and Geriatric Sciences"Sapienza" UniversityPoliclinico Umberto I00161 RomeItaly Department of Heart and Great Vessels " A.Reale""Sapienza" UniversityPoliclinico Umberto I00161 RomeItaly 

出 版 物：《World Journal of Anesthesiology》 (世界麻醉学杂志)

年 卷 期：2013年第2卷第2期

页      面：14-17页

学科分类：10[医学] 

主　　题：General anesthesia Electrochemotherapy Pace-maker Implantable cardioverter defibrillator Tumor ablation Metastatic skin cancer 

摘      要：Electrochemotherapy(ECT) is a recently described therapy that relies on the permeation of cancer cell membranes by electrical pulses to enhance cytotoxic drug penetration. It has been successfully used in the treatment of primary and metastatic skin cancer. Systemic chemotherapy is the most commonly used therapeutic strategy, and the prevailing orientation calls for the administration of the maximum tolerated dose; however, considerable limitations exist including toxicities to healthy tissues and low achievable drug concentrations at tumor sites. We reported a case of an 83-years-old patient with a laterocervical metastasis of a squamous epidermoidal lip cancer. The patient had a complex medical history and an implantable cardioverter defibrillator(ICD)/pace-maker. The lesion was localized in the supraclavicular right side with a distance from the pace-maker/ICD about 5 cm, but the nodule was not deeply located. The ECT was performed un-der general anesthesia and particular attention we put on the interference with the functioning of the heart. The synchronization algorithm currently implemented in Clinoporator Vitae device coupled with the external triggering device Accu Sync proved to be effective in preventing external stimulation of the heart during the so-called vulnerable period of the ventricles. As a result all electroporation pulses in our study were delivered outside the vulnerable period and no heart arrhythmias or any other pathological morphological changes were observed. The safety of treatment was demonstrated also by absence of side effects during and after ECT.