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Review
. 2020 Apr;30(Suppl 1):S33-S37.
doi: 10.4103/jcecho.jcecho_8_19. Epub 2020 Apr 10.

Atrial Fibrillation, Cancer and Echocardiography

Maurizio Galderisi  1 , Roberta Esposito  1 , Regina Sorrentino  1 , Lucia La Mura  1 , Ciro Santoro  1 , Antonella Tufano  2
Affiliations
Review

Atrial Fibrillation, Cancer and Echocardiography

Maurizio Galderisi et al. J Cardiovasc Echogr. 2020 Apr.

Abstract

Nonvalvular atrial fibrillation (AF) is a relatively frequent arrhythmia in cancer patients; it is possibly due to direct effect of cancer or consequence of cancer therapies. AF creates important problems for both therapeutic management and prognosis in cancer patients. The anticoagulation of cancer patients presenting AF is a main issue because of the difficult balance between thromboembolic and bleeding risks, both elevated in this clinical setting. A comprehensive echo Doppler examination is mandatory to identify the eventual sources of emboli in left atrial (LA) cavity, mainly the transesophageal echocardiography (TEE), but also to predict the subsequent development of heart failure. This evaluation is particularly important to graduate anticoagulation and to prevent and manage symptoms/signs of heart failure. The performance of a TEE precardioversion is highly encouraged to detect possible thrombi in LA appendage. A careful assessment of LA size (LA volume index) and function (LA emptying fraction and/or LA strain) should always be planned to predict the possible recurrence of AF paroxysmal episodes. This is in fact a key action, not only from the cardiologic point of view but also for the oncologic perspectives in individual situations. Patients with larger left atrium and more impaired LA function should be addressed toward a less aggressive cancer treatment, with drugs which are not associated or are poorly related with the risk of AF development. A correct and comprehensive echocardiographic assessment could even induce the oncologist to change the cancer management balancing the oncologic and the cardiac risk.

Keywords: Anticoagulation; atrial fibrillation; cancer; echocardiography; left atrial strain; left atrial volume index.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Left atrial dilation in a breast cancer patient with paroxysmal atrial fibrillation. In the top, transmitral pattern showing the absence of A velocity due to atrial fibrillation. In the bottom, left atrial volume in apical four-chamber (left) and two-chamber (right) part. Left atrial volume index is 46.2 ml/m2
Figure 2
Figure 2
Reduction of left atrial strain in apical two-chamber view in a patient with chronic lymphatic leukemia experiencing paroxysmal atrial fibrillation during ibrutinib therapy
See this image and copyright information in PMC

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