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

World Journal of Anesthesiology 2013年第2期2卷 14-17页

作者： Maurizio Marandola Alida Albante Raffaele Quaglione Claudia Lucci matteo chiaretti Luigi Tritapepe Department of Cardiovascular RespiratoryNephrologicAnesthesiologic and Geriatric Sciences"Sapienza" UniversityPoliclinico Umberto I00161 RomeItaly Department of Heart and Great Vessels " A.Reale" "Sapienza" UniversityPoliclinico Umberto I00161 RomeItaly

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.

关键词： General anesthesia Electrochemotherapy Pace-maker Implantable cardioverter defibrillator Tumor ablation Metastatic skin cancer

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