Cardiac Arrhythmias and CNS tumors: Cranial Radiation Induced Paroxysmal Atrial Fibrillation Status Post Resection of Glioblastoma Multiforme

Arrhythmias are quite common in patients diagnosed with cancer. Several etiologies have been identified which includes increased pro-arrhythmic effect of chemotherapeutic agents, immunological phenomenon from use of immunotherapy and the impact of ionizing radiation on organs in the body.

With regards to treatment, radiation to the chest wall for cardiothoracic malignancies has been implicated as having the highest frequency of occurrence for atrial fibrillation. Injury to the conductive system of the heart has been associated with this event. CNS malignancies such as glioblastoma multiforme have been predicted to increase risk of arrhythmias. This is even more pronounced after a craniotomy and brain resection. It has been hypothesized that alteration of neuronal circuits in the Central nervous system especially in the cardiovascular centers of the medulla oblongata could increase the release of catecholamines leading to tachyarrhythmias. Though more evidences are needed to support this, the coexistence of Paroxysmal atrial fibrillation and nausea in our patient after commencement of radiation further strengthens our view, as it is a well-known fact that the medulla oblongata houses both the chemoreceptor trigger zone for nausea/vomiting and the cardiovascular centers.

New onset Paroxysmal atrial fibrillation should be anticipated in patients with CNS malignancies that undergo brain radiotherapy. The risk of brain bleed from anti-coagulation is high especially in the immediate post-operative period. Nevertheless, monitoring for both symptomatic and occult atrial fibrillation is a sine qua non.

output by altering the activities of the vagus nerve.

We hereby present a case of a 61-year-old male with a left parietal mass, status post resection and histologically confirmed Glioblastoma multiforme WHO stage 4 with new onset Paroxysmal Atrial fibrillation after commencement of radiation.