Doxorubicin-associated delayed ventricular fibrillation in acute promyelocytic leukemia

A 16-year-old schoolgirl presented with acute promyelocytic leukemia. 10 days after induction chemotherapy with doxorubicin and cytosine arabinoside together with heparinisation for the accompanying disseminated intravascular coagulopathy, she developed ventricular fibrillation. Following successful cardiac resuscitation a gated blood pool scan showed a left ventricular ejection fraction of 49%. Despite this event the patient was subsequently rechallenged with doxorubicin without any adverse cardiac effect. The exact mechanism for this delayed doxorubicin-associated cardiac arrhythmia is not clear, but electrolyte disturbance and heparin-doxorubicin interaction may have played a contributory role.