Ventricular fibrillation after bortezomib therapy in a patient with systemic amyloidosis

Abstract

A 64-year-old female was diagnosed with systemic amyloidosis associated with multiple myeloma. Bortezomib and dexamethasone-therapy was initiated; however, she developed lethal ventricular fibrillation (VF) and cardiac arrest after 84 hours of therapy. Cardiopulmonary resuscitation using direct current shocks with epinephrine and amiodarone was initiated but failed to receive cardiac function. Although her arterial pulsations recovered immediately after the injection of vasopressin, she died of heart failure 8 hours after the onset of VF. Cardiac amyloidosis was verified by autopsy. Although the direct association of bortezomib with lethal VF remained to be clarified in our patient, the current report emphasizes on bortezomib as a substantial risk factor for cardiomyocyte damage. The potential risk of lethal events associated with cardiac amyloidosis should be carefully considered during bortezomib treatment for patients with AL amyloidosis.

Keywords: bortezomib; multiple myeloma; systemic amyloidosis; ventricular fibrillation.

Figure 1.

A) Low-voltage of QRS complexes and the absence of P wave in all leads on electrocardiography (ECG) performed on hospital admission. B) The results of 24-h Holter ECG reveal a long pause (arrow) and short-run of premature contractions (asterisks). C) Results from a continuous bed-side monitoring device during 1 week around bortezomib subcutaneous injections. The day when the cardiac arrest occurred is referred to as day 0. DEXA, dexamethasone. D) Histopathological analyses of the region of atrioventricular nodes. Deposits of amorphous materials (arrows) can be seen in a hematoxylin and eosin stained section (x100). E) The amorphous deposits (arrows) are stained positively by Congo-red (x100). The asterisks indicate perivascular amorphous materials that are positively stained with Congo-red.