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. 2021 Oct 15;10(3):195-210.
doi: 10.1055/s-0041-1731907. eCollection 2021 Sep.

Bradyarrhythmias in Cardio-Oncology

Marta Fonseca  1   2 , Evaline Cheng  3 , Duc Do  3 , Shouvik Haldar  4   5 , Shelby Kutty  6 , Eric H Yang  3 , Arjun K Ghosh  1   2 , Avirup Guha  7   8   9
Affiliations

Bradyarrhythmias in Cardio-Oncology

Marta Fonseca et al. South Asian J Cancer. .

Abstract

The relationship between bradyarrhythmias and cancer therapies has not been well described but is increasingly recognized. There have been extensive advances in oncological pharmacotherapy, with several new classes of drugs available including targeted agents, immune checkpoint inhibitors and CAR T cell therapy. This increasing repertoire of available drugs has revolutionized overall prognosis and survival of cancer patients but the true extent of their cardiovascular toxicity is only beginning to be understood. Previous studies and published reviews have traditionally focused on conventional chemotherapies and in arrhythmias in general, particularly tachyarrhythmias. The number of patients with both cancer and cardiovascular problems is increasing globally and oncologists and cardiologists need to be adept at managing arrythmia based scenarios. Greater collaboration between the two specialties including studies with prospective data collection in Cardio-Oncology are much needed to fill in knowledge gaps in this arena. This case-based review summarizes current available evidence of cancer treatment-related bradyarrhythmia incidence (including its different subtypes), possible mechanisms and outcomes. Furthermore, we propose a stepwise surveillance and management protocol for patients with suspected bradyarrhythmia related to cancer treatment.

Keywords: bradyarrhythmia; cardio-oncology; checkpoint inhibitors; drug–drug interaction; radiation therapy.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

None
Avirup Guha
Fig. 1
Fig. 1
Immune checkpoint inhibitor-induced bradyarrhythmia ECG (case 2). ECG, electrocardiogram.
Fig. 2
Fig. 2
Radiation-induced bradyarrhythmia ECG (case 3). ECG, electrocardiogram.
Fig. 3
Fig. 3
Radiation-induced bradyarrhythmia ECG (case 4). ECG, electrocardiogram.
Fig. 4
Fig. 4
Drug–Drug interactions between anticancer and nodal blocking agents (created by biorender.com).
Fig. 5
Fig. 5
Proposed algorithm for the management of bradycardia/bradyarrhythmia, with a special focus on ICI- and radiation-induced conduction abnormalities w (created by biorender.com). CK, creatine kinase; CMR, cardiac magnetic resonance; CRP, C-reactive protein; CXR, chest X-ray; ECG, electrocardiogram; EMB, endomyocardial biopsy; ESR, erythrocyte sedimentation rate; NT proBNP, N-terminal pro-brain natriuretic peptide; TTE, transthoracic echocardiography; WBC, white blood cell count.
See this image and copyright information in PMC

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