Prolongation of the QT interval and ventricular tachycardia in patients treated with arsenic trioxide for acute promyelocytic leukemia

Ann Intern Med. 2000 Dec 5;133(11):881-5. doi: 10.7326/0003-4819-133-11-200012050-00012.


Background: Recently, arsenic trioxide has increasingly been used for relapsed acute promyelocytic leukemia. However, it is known to have several adverse effects, including acute cardiac toxicities.

Objective: To determine cardiac toxicities resulting from arsenic trioxide therapy in patients with relapsed or refractory acute promyelocytic leukemia.

Design: Phase II clinical prospective cohort study.

Setting: A university hospital in Hamamatsu, Japan.

Patients: 8 patients with relapsed acute promyelocytic leukemia.

Intervention: Arsenic trioxide, 0.15 mg/kg of body weight, administered daily by 2-hour infusion for a maximum of 60 days.

Measurements: Continuous monitoring with ambulatory electrocardiography.

Results: Five patients (63%) achieved complete remission. During induction therapy with arsenic trioxide, prolonged QT intervals were observed in all patients. Ventricular premature contractions were noticed during 8 of 12 courses of therapy. Four patients developed nonsustained ventricular tachycardia and required treatment with antiarrhythmic agents.

Conclusions: Cardiac toxicity occurs during arsenic trioxide therapy in patients with acute promyelocytic leukemia. Such patients should be monitored for prolonged QT intervals and ventricular arrhythmia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / adverse effects*
  • Arsenic Trioxide
  • Arsenicals / adverse effects*
  • Electrocardiography, Ambulatory
  • Female
  • Humans
  • Leukemia, Promyelocytic, Acute / drug therapy*
  • Long QT Syndrome / chemically induced*
  • Male
  • Middle Aged
  • Oxides / adverse effects*
  • Prospective Studies
  • Recurrence
  • Remission Induction
  • Tachycardia, Ventricular / chemically induced*


  • Antineoplastic Agents
  • Arsenicals
  • Oxides
  • Arsenic Trioxide