case_images: PMC9557095_01
case_images: PET-CT, serial Holter monitoring, and ECG. (A) PET-CT showing peripheral pulmonary carcinoma and brain metastasis (arrowheads); (B) Holter monitoring on admission showing prolonged QTc interval (QTcB 640 ms); (C) Holter monitoring on admission showing frequent VTs and TdP (arrowheads); (D) ECG with a temporary pacemaker and overdrive pacing at 110 bpm (QTcB 298 ms); (E) Holter monitoring with a temporary pacemaker and pacing at 70 bpm (QTcB 507 ms); (F) ECG at discharge showing near-normal QTc interval (QTcB 477 ms). VT, ventricular tachycardia; TdP, torsade de pointes; QTcB, QTc interval calculated with Bazett formula; PET-CT, positron emission tomography - computed tomography; ECG, electrocardiogram.
case_images: fcvm-09-934214-g0001.jpg
case_images: PMC9557095_01_fcvm-09-934214-g0001.jpg
case_images: F1
case_images: Seventeen months previously, the patient had been diagnosed with peripheral lung adenocarcinoma and associated brain and bone metastases (Figure 1A). Holter analysis also showed prolonged QTc intervals (longest QTcB 640 ms, Figure 1B), frequent VPCs, and ventricular tachycardias (VTs) (122 episodes/20 h, including multiple TdP) (Figure 1C). An ECG that had been conducted prior to osimertinib treatment showed normal QTc intervals (QTcB 417 ms, Supplementary Figure 1A). The initial pacing rate of 110 bpm was gradually reduced to 60--70 bpm within 1 week, and the QTc interval was shortened to 298-507 msec (Figures 1D,E). At discharge, the patient's symptoms were relieved and her ECG showed normal results (QTc 477 ms) (Figure 1F, Supplementary Figure 1B). Three- (Supplementary Figure 1C) and 6-month follow-ups showed good recovery and normal ECG results (Table 1).