Dexamethasone suppresses long QT phenotype in patient with acute promyelocytic leukemia treated with arsenic Jeffrey R. Winterfield, MD, FHRS, David.

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Dexamethasone suppresses long QT phenotype in patient with acute promyelocytic leukemia treated with arsenic Jeffrey R. Winterfield, MD, FHRS, David J. Milan, MD HeartRhythm Case Reports Volume 2, Issue 4, Pages 280-282 (July 2016) DOI: 10.1016/j.hrcr.2015.07.010 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: A baseline electrocardiogram, recorded at presentation, with QTc prolongation measuring ~508 milliseconds prior to administration of arsenic or other potential QT-prolonging agents. B: An electrocardiogram recorded June 29, 2013, after dexamethasone reduces QTc. Dexamethasone had been administered for nausea, and we observed QTc reduction to ~478 milliseconds. HeartRhythm Case Reports 2016 2, 280-282DOI: (10.1016/j.hrcr.2015.07.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 A: Marked correct QT (QTc) prolongation to 581 milliseconds during the first cycle of consolidation chemotherapy with arsenic, which resulted in therapy discontinuation and inpatient admission for monitoring. The QTc returned to baseline following the cessation of arsenic treatment. B: Rescue of arsenic-triggered QTc prolongation with dexamethasone. QTc measurements (blue bars indicate measurement points) during arsenic administration before and after administration of high-dose dexamethasone. HeartRhythm Case Reports 2016 2, 280-282DOI: (10.1016/j.hrcr.2015.07.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Corrected QT (QTc) measurements during treatment with arsenic and dexamethasone. Temporal declines in QTc correlated with cessation of arsenic therapy and also with dexamethasone treatment. HeartRhythm Case Reports 2016 2, 280-282DOI: (10.1016/j.hrcr.2015.07.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions