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Review
. 2021 Jul 20;144(3):e41-e55.
doi: 10.1161/CIR.0000000000000986. Epub 2021 Jun 17.

Recognition, Prevention, and Management of Arrhythmias and Autonomic Disorders in Cardio-Oncology: A Scientific Statement From the American Heart Association

Michael G Fradley, Theresa M Beckie, Sherry Ann Brown, Richard K Cheng, Susan F Dent, Anju Nohria, Kristen K Patton, Jagmeet P Singh, Brian Olshansky
Review

Recognition, Prevention, and Management of Arrhythmias and Autonomic Disorders in Cardio-Oncology: A Scientific Statement From the American Heart Association

Michael G Fradley et al. Circulation. .

Abstract

With the advent of novel cancer therapeutics and improved screening, more patients are surviving a cancer diagnosis or living longer with advanced disease. Many of these treatments have associated cardiovascular toxicities that can manifest in both an acute and a delayed fashion. Arrhythmias are an increasingly identified complication with unique management challenges in the cancer population. The purpose of this scientific statement is to summarize the current state of knowledge regarding arrhythmia identification and treatment in patients with cancer. Atrial tachyarrhythmias, particularly atrial fibrillation, are most common, but ventricular arrhythmias, including those related to treatment-induced QT prolongation, and bradyarrhythmias can also occur. Despite increased recognition, dedicated prospective studies evaluating true incidence are lacking. Moreover, few studies have addressed appropriate prevention and treatment strategies. As such, this scientific statement serves to mobilize the cardio-oncology, electrophysiology, and oncology communities to develop clinical and scientific collaborations that will improve the care of patients with cancer who have arrhythmias.

Keywords: AHA Scientific Statements; antiarrhythmic agents; anticoagulants; arrhythmias, cardiac; cardiotoxicity; medical oncology.

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Conflict of interest statement

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

Figures

Figure 1.
Figure 1.. Mechanisms of systemic cancer therapy–induced arrhythmias.
CAR-T indicates chimeric antigen receptor T cell.
Figure 2.
Figure 2.. Algorithm for the management of atrial fibrillation during cancer treatment.
5FU indicates 5-fluorouracil; CCB, calcium channel blocker; LVH, left ventricular hypertrophy; and TEE, transesophageal echocardiography *Vaughan Williams Classification.
Figure 3.
Figure 3.. Algorithm for the management of atrial fibrillation–associated thromboembolism prophylaxis during cancer Treatment.
HAS-BLED indicates hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly; and LMWH, low-molecular-weight heparin. *Anticoagulation therapy should be determined based on an individualized shared decision-making approach.
See this image and copyright information in PMC

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