Treatment Options in AF Patients with Cancer; Focus on Catheter Ablation

Abstract

Longer life expectancy along with advancements in cancer and atrial fibrillation (AF) therapies and treatment strategies have led to an increase in the number of individuals with both diseases. As a result, the complicated management of these patients has become crucial, necessitating individualised treatment that considers the bi-directional relationship between these two diseases. On the one hand, giving appropriate pharmaceutical therapy is exceptionally difficult, considering the recognised thromboembolic risk posed by AF and malignancy, as well as the haemorrhagic risk posed by cancer. The alternative pulmonary vein isolation (PVI) ablation, on the other hand, has been inadequately explored in the cancer patient population; there is yet inadequate data to allow the clinician to unambiguously select patients that can undertake this therapeutic intervention. The goal of this review is to compile the most valuable data and supporting evidence about the characteristics, care, and therapy of cancer patients with AF. Specifically, we will evaluate the pharmaceutical options for a proper anticoagulant therapy, as well as the feasibility and safety of PVI in this population.

Keywords: anticoagulation; atrial fibrillation; cancer; cardio-oncology; pulmonary vein isolation ablation.

Figure 1

Overview of possible therapeutic strategies for atrial fibrillation in cancer patients. The main therapeutic strategies used to treat atrial fibrillation have only been partially explored in the cancer patient. Although a number of studies have advanced our knowledge of how to manage the oncological patient with atrial fibrillation, there are still a fair number of questions that have not yet been fully answered. Created with Biorender.com (accessed on 13 July 2022).