Rates and risk of arrhythmias in cancer survivors with chemotherapy-induced cardiomyopathy compared with patients with other cardiomyopathies

Abstract

ObjectivesThere is little information about arrhythmia burden in cancer survivors with chemotherapy-induced cardiomyopathy (CIC). We hypothesise that the rates and risk of arrhythmias will be similar in CIC when compared with other non-ischaemic cardiomyopathy (NICMO) aetiologies.MethodsWe retrospectively identified nine patients with CIC and an implantable defibrillator and 18 age and sex-matched control patients (nine patients with NICMO and nine patients with ischaemic cardiomyopathy (ICMO)). Rates and odds of arrhythmias were calculated by type of cardiomyopathy, adjusting for days since implantable cardioverter defibrillator implantation, history of atrial fibrillation and length of follow-up using logistic regression analysis.ResultsCompared with patients with NICMO, rates and adjusted odds were similar for patients with CIC for atrial arrhythmias (44.4% vs 33.3%; adjusted OR=1.89; 95% CI0.17 to 21.03; P=0.61), non-sustained ventricular tachycardia (NSVT) (44.4% vs 33.3%; OR=2.10; 95% CI 0.21 to 20.56; P=0.53), and the combined outcome of NSVT, sustained ventricular tachycardia and/or ventricular fibrillation (44.4% vs 44.4%; OR=2.70; 95% CI 0.25 to 29.48; P=0.42). Conversely, compared with patients with NICMO, patients with ICMO demonstrated higher rates and adjusted odds of the combined outcome (88.9% vs 44.4%; OR=28.60; 95% CI 1.26 to 648.2; P=0.04) and NSVT (77.8% vs 33.3%; OR=8.95; 95% CI 0.90 to 88.94; P=0.06).ConclusionsWhile tentative based on sample size, rates of arrhythmias in patients with CIC appear to be similar to those experienced by patients with other forms of NICMO.

Cancer Radiation Therapy May Be Associated With Atrial Fibrillation

“…There are several hypotheses that could explain the higher prevalence of AF in cancer patients as it relates to the cancer itself or to the cancer treatment. These hypotheses include inflammation, which plays a key role both in carcinogenesis and AF (20,21), cardiotoxicity caused by chemotherapy (22,23), surgical treatment leading to postoperative AF, and autonomic dysfunction in cancer patients that may lead to increased sympathetic nervous system function (24,25).…”

Heart rhythm and conduction disorders as manifestations of cardiotoxicity of anticancer treatment: myth or reality?

“…Anthracyclines, small molecule tyrosine kinase inhibitors, and histone deacetylases exert the most pronounced effects on intraventricular conductivity. [13][14][15][16][17][18][19][20][21] В настоящее время выделяют корригируемые и некорригируемые факторы риска удлинения интервала QT во время химиотерапии. К корригируемым факторам относятся электролитные нарушения, в частности гипокалиемия (К + ≤ 3,5 ммоль/л), гипомагниемия (Mg 2+ ≤ 0,7 ммоль/л), гипокальциемия (Ca 2+ ≤ 2,1 ммоль/л), прием петлевых диуретиков, гипотиреоз, тошнота и диарея у пациентов.…”

“…По данным исследования, неустойчивая желудочковая тахикардия возникала у 44% пациентов с токсической кардиомиопатией, что несколько превышало частоту выявления аритмии у пациентов с дилатационной (неишемической) кардиомиопатией (30%), но уступало данным в группе кардиомиопатии ишемической природы (76%). Авторы исследования предполагают, что проаритмогенное действие антрациклинов связано с нарушением работы кальциевых каналов, изменением потенциала действия и избыточным накоплением токсических веществ [20]. В работе S. Kilickap и соавт.…”

“…Data of study showed that unstable ventricular tachycardia occurred in 44% of patients with toxic cardiomyopathy, which slightly exceeded the incidence of arrhythmia detection in patients with dilated (non-ischemic) cardiomyopathy (30%), but it was lower compared to data from the group of ischemic cardiomyopathy (76%). The authors of study hypothesize that the proarrhythmic effects of anthracyclines are related to calcium channel disorders, changes in action potential, and excessive accumulation of toxic substances [20]. S. Kilickap et al studied 29 oncologic patients receiving doxorubicin.…”

“…The dysfunction of sinus node with the development of asymptomatic sinus bradycardia was detected in patient receiving taxanes (paclitaxel). Review paper by E. Rowinsky et al presents data that this cardiac rhythm disorder was registered in 29% of patients participating in phase II clinical trial of pacl- [13][14][15][16][17][18][19][20][21] сел). В обзоре E. Rowinsky и соавт.…”