What happened, in summary

A 75-year-old woman had lung adenocarcinoma diagnosed in 2012, staged T1N0M0 Stage I and negative for driver genes. She underwent radical resection of the right middle lung lobe. In May 2016, follow-up imaging showed a right upper-lobe nodule suggesting recurrence, and she received first-line and second-line chemotherapy. By March 2019, imaging showed progressive disease, and she started oral anlotinib 12 mg once daily for 14 days followed by a 7-day break in each 21-day cycle. After about 5 months on anlotinib, she presented in August 2019 with 1 week of palpitations and chest discomfort. Her heart rate was 36 beats per minute. Electrocardiogram showed sinus bradycardia, T-U fusion, and a prolonged QT interval. A 24-hour Holter monitor showed a minimum heart rate of 30 beats per minute, 5 pauses longer than 2 seconds, the longest RR interval at 2.041 seconds, widespread ST-T changes, and prolonged QT interval. The case identified sick sinus syndrome during anlotinib treatment. Unlike the second patient in the same report, whose symptoms resolved after stopping anlotinib, this patient received a dual-chamber permanent pacemaker. She remained alive under follow-up. This is a recurrent/progressive NSCLC story complicated by serious cardiac rhythm toxicity during anlotinib treatment, not a simple Stage I survivor story. Later cancer status after pacemaker placement was not fully reported, so the outcome remains conservative as living with cancer. Palpitations, syncope, chest discomfort, or marked bradycardia during anlotinib should prompt ECG and rhythm monitoring. The report also described a second anlotinib-treated patient whose symptoms resolved after stopping the drug, but this 75-year-old woman followed a different path because permanent pacing was chosen. That distinction supports keeping the pacemaker in the treatment narrative without assuming cancer remission.