Case Report
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World J Anesthesiol. Jul 27, 2013; 2(2): 14-17
Published online Jul 27, 2013. doi: 10.5313/wja.v2.i2.14
Electrochemotherapy and heart function: Treatment in a patient with implantable cardioverter defibrillator/pace-maker
Maurizio Marandola, Alida Albante, Raffaele Quaglione, Claudia Lucci, Matteo Chiaretti, Luigi Tritapepe
Maurizio Marandola, Alida Albante, Luigi Tritapepe, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, “Sapienza” University, Policlinico Umberto I, 00161 Rome, Italy
Raffaele Quaglione, Claudia Lucci, Matteo Chiaretti, Department of Heart and Great Vessels “ A.Reale”, “Sapienza” University, Policlinico Umberto I, 00161 Rome, Italy
Author contributions: All the authors contributed equally to this manuscript.
Correspondence to: Marandola Maurizio, MD, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, “Sapienza” University, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy. maurizio.marandola@uniroma1.it
Telephone: +39-6-49972692 Fax: +39-6-49972595
Received: April 4, 2013
Revised: April 24, 2013
Accepted: May 7, 2013
Published online: July 27, 2013
Processing time: 59 Days and 23.8 Hours
Abstract

Electrochemotherapy (ECT) is a recently described therapy that relies on the permeation of cancer cell membranes by electrical pulses to enhance cytotoxic drug penetration. It has been successfully used in the treatment of primary and metastatic skin cancer. Systemic chemotherapy is the most commonly used therapeutic strategy, and the prevailing orientation calls for the administration of the maximum tolerated dose; however, considerable limitations exist including toxicities to healthy tissues and low achievable drug concentrations at tumor sites. We reported a case of an 83-years-old patient with a laterocervical metastasis of a squamous epidermoidal lip cancer. The patient had a complex medical history and an implantable cardioverter defibrillator (ICD)/pace-maker. The lesion was localized in the supraclavicular right side with a distance from the pace-maker/ICD about 5 cm, but the nodule was not deeply located. The ECT was performed under general anesthesia and particular attention we put on the interference with the functioning of the heart. The synchronization algorithm currently implemented in Clinoporator Vitae device coupled with the external triggering device AccuSync proved to be effective in preventing external stimulation of the heart during the so-called vulnerable period of the ventricles. As a result all electroporation pulses in our study were delivered outside the vulnerable period and no heart arrhythmias or any other pathological morphological changes were observed. The safety of treatment was demonstrated also by absence of side effects during and after ECT.

Keywords: General anesthesia; Electrochemotherapy; Pace-maker; Implantable cardioverter defibrillator; Tumor ablation; Metastatic skin cancer

Core tip: We reported a case of treatment with electrochemotherapy (ECT) for a metastatic skin cancer in a patient with a complex cardiological history. The safety of the treatment was demonstrated by absence of side effects during and after ECT.