FOLFOX-Associated Ventricular Fibrillation Arrest in a Patient With Colon Cancer.

BACKGROUND

Fluoropyrimidine cardiotoxicity is uncommon but may cause life-threatening ventricular arrhythmias.

CASE SUMMARY: A 43-year-old man with stage IIIB colon cancer developed chest discomfort and out-of-hospital ventricular fibrillation arrest approximately 72 hours after his first folinic acid (leucovorin), fluorouracil (5-FU), and oxaliplatin (FOLFOX) cycle. Electrocardiography showed anterior ST-segment elevations, but coronary angiography demonstrated nonobstructive left and right coronary arteries. Echocardiography showed a left ventricular ejection fraction of 25% to 30%, which improved to approximately 50% on cardiac magnetic resonance imaging without myocardial edema or late gadolinium enhancement. FOLFOX was discontinued, guideline-directed medical therapy was initiated, and an extravascular implantable cardioverter-defibrillator was placed for secondary prevention.

DISCUSSION: This case highlights a rare, severe presentation of fluoropyrimidine cardiotoxicity after the first treatment cycle despite no prior cardiac history.

TAKE-HOME MESSAGE: Ventricular fibrillation may occur early during FOLFOX therapy. Prompt recognition and multidisciplinary cardio-oncology management are essential.