Oxaliplatin and amlodipine combination induced reversible Brugada phenocopy: A case report

Brugada syndrome (BrS) is a rare and life-threatening cardiac electrophysiological disease, characterized by typical electrocardiogram changes and malignant arrhythmia, which is easy to induce sudden cardiac death. The combination of modified FOLFOX (mFOLFOX) chemotherapy regimen and amlodipine is common in clinical practice, but the Brugada phenocopy (BrP) induced by the combination of mFOLFOX and amlodipine is rarely reported. And its arrhythmogenic mechanism is still unclear.

A 53-year-old man with rectal cancer was treated with amlodipine besylate on a long-term basis. The Brugada type 1 pattern was identified during routine electrocardiogram (ECG) screening before the tenth chemotherapy.

Drug-induced type 1 Brugada phenotype.

The patient declined further testing (e.g., drug challenge testing, SCN5A genetic testing). Under close monitoring, the tenth cycle of mFOLFOX chemotherapy was successfully completed.

No cardiac adverse reactions occurred during chemotherapy. During subsequent cycles of chemotherapy, the electrocardiogram continued to show BrP type 1 but resolved 27 days after the last chemotherapy. No long-term cardiac complications occurred.

In this paper, we analyzed the possible mechanism of oxaliplatin combined with amlodipine induced reversible type 1 BrP, so as to provide clinical reference for the safe medication of chemotherapy patients. At the same time, it is suggested that clinicians should pay attention to the risk of synergistic inhibition of ion channels when chemotherapy drugs are combined with antihypertensive drugs, which provides key clinical evidence for reducing the incidence of cardiovascular complications and optimizing multi-drug combination therapy in cancer patients.