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Hawryszko M, Sławiński G, Tomasik B, Lewicka E. Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review. Cancers (Basel) 2023; 15:5723. [PMID: 38136269 PMCID: PMC10741954 DOI: 10.3390/cancers15245723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/25/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
Cardio-oncology currently faces one of the greatest challenges in the field of health care. The main goal of this discipline is to ensure that patients treated for cancer do not suffer or die from cardiovascular disease. The number of studies on the mechanisms of heart injury during cancer treatment is constantly increasing. However, there is insufficient data on heart rhythm disorders that may result from this treatment. This issue seems to be particularly important in patients with lung cancer, in whom anticancer therapy, especially radiotherapy, may contribute to the onset of cardiac arrhythmias. The observed relationship between cardiac dosimetry and radiotherapy-induced cardiotoxicity in lung cancer treatment may explain the increased mortality from cardiovascular causes in patients after chest irradiation. Further research is essential to elucidate the role of cardiac arrhythmias in this context. Conversely, recent reports have highlighted the application of stereotactic arrhythmia radioablation (STAR) in the treatment of ventricular tachycardia. This review of available studies on the epidemiology, pathogenesis, diagnosis, and treatment of arrhythmias in patients treated for lung cancer aims to draw attention to the need for regular cardiological monitoring in this group of patients. Improving cardiac care for patients with lung cancer has the potential to enhance their overall therapeutic outcomes.
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Affiliation(s)
- Maja Hawryszko
- Department of Cardiology and Heart Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17 Street, 80-214 Gdansk, Poland; (M.H.); (E.L.)
| | - Grzegorz Sławiński
- Department of Cardiology and Heart Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17 Street, 80-214 Gdansk, Poland; (M.H.); (E.L.)
| | - Bartłomiej Tomasik
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17 Street, 80-214 Gdansk, Poland;
| | - Ewa Lewicka
- Department of Cardiology and Heart Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17 Street, 80-214 Gdansk, Poland; (M.H.); (E.L.)
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Flore F, Scacciavillani R, Iannaccone G, Narducci ML, Pinnacchio G, Bencardino G, Perna F, Spera FR, Comerci G, Camilli M, Lombardo A, Lanza GA, Crea F, Pelargonio G. Mechanisms, prevalence and management of cardiac arrhythmias in cancer patients: a comprehensive review. Future Cardiol 2023; 19:707-718. [PMID: 37929680 DOI: 10.2217/fca-2023-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Recently, prognosis and survival of cancer patients has improved due to progression and refinement of cancer therapies; however, cardiovascular sequelae in this population augmented and now represent the second cause of death in oncological patients. Initially, the main issue was represented by heart failure and coronary artery disease, but a growing body of evidence has now shed light on the increased arrhythmic risk of this population, atrial fibrillation being the most frequently encountered. Awareness of arrhythmic complications of cancer and its treatments may help oncologists and cardiologists to develop targeted approaches for the management of arrhythmias in this population. In this review, we provide an updated overview of the mechanisms triggering cardiac arrhythmias in cancer patients, their prevalence and management.
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Affiliation(s)
- Francesco Flore
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gaetano Pinnacchio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Gianluca Comerci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Massimiliano Camilli
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Fradley MG, Beckie TM, Brown SA, Cheng RK, Dent SF, Nohria A, Patton KK, Singh JP, Olshansky B. Recognition, Prevention, and Management of Arrhythmias and Autonomic Disorders in Cardio-Oncology: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e41-e55. [PMID: 34134525 DOI: 10.1161/cir.0000000000000986] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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.
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Rao VU, Reeves DJ, Chugh AR, O'Quinn R, Fradley MG, Raghavendra M, Dent S, Barac A, Lenihan D. Clinical Approach to Cardiovascular Toxicity of Oral Antineoplastic Agents: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2693-2716. [PMID: 34045027 DOI: 10.1016/j.jacc.2021.04.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022]
Abstract
Precision medicine has ushered in a new era of targeted treatments for numerous malignancies, leading to improvements in overall survival. Unlike traditional chemotherapy, many molecular targeted antineoplastic agents are available in oral formulation, leading to enhanced patient convenience and a perception of reduced risk of adverse effects. Although oral antineoplastic agents are generally well-tolerated, cardiovascular toxicities are being reported with increasing frequency in part due to U.S. Food and Drug Administration and manufacturer recommended cardiac monitoring. Monitoring strategies have focused on left ventricular dysfunction, hypertension, and QT prolongation/arrhythmias. Given the rapid pace of development and availability of new oral antineoplastic agents, the purpose of this review is to provide clinicians with an up-to-date practical approach to monitoring and management of cardiovascular toxicities with the aim of improving overall outcomes for patients with cancer.
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Affiliation(s)
- Vijay U Rao
- Franciscan Cardio-Oncology Center, Indiana Heart Physicians, Franciscan Health, Indianapolis, Indiana, USA.
| | - David J Reeves
- Division of Oncology, Franciscan Health and Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana, USA
| | - Atul R Chugh
- Franciscan Cardio-Oncology Center, Indiana Heart Physicians, Franciscan Health, Indianapolis, Indiana, USA
| | - Rupal O'Quinn
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghana Raghavendra
- Franciscan Cardio-Oncology Center, Oncology and Hematology Specialists, Franciscan Health, Indianapolis, Indiana, USA
| | - Susan Dent
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Ana Barac
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Daniel Lenihan
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
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5
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Lee C, Maan A, Singh JP, Fradley MG. Arrhythmias and device therapies in patients with cancer therapy-induced cardiomyopathy. Heart Rhythm 2021; 18:1223-1229. [PMID: 33640446 DOI: 10.1016/j.hrthm.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
Our knowledge of associated cardiotoxicities from novel therapeutics in oncology continues to expand. These include arrhythmias from cancer-therapy induced cardiomyopathy resulting from both direct and indirect effects on cardiomyocytes and other mechanisms that can adversely impact cardiovascular outcomes and overall mortality. In this review, we focus on both the arrhythmias of various classes of oncologic agents as well as the use of cardiac implantable electronic devices (cardioverter-defibrillators, permanent pacemakers, and cardiac resynchronization therapy) in cardio-oncology patients.
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Affiliation(s)
- Charlotte Lee
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Abhishek Maan
- Department of Cardiac Electrophysiology, The Mount Sinai Hospital, New York, New York
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Sequeira AR, Bhandari A, Kilpatrick B, Fradley MG, Mohanty BD. Managing thromboembolic risk from atrial fibrillation in patients with cancer: a role for nonpharmacologic approaches. Future Cardiol 2020; 16:687-693. [PMID: 32643392 DOI: 10.2217/fca-2020-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Atrial fibrillation (AF) in the setting of malignancy poses a unique challenge given the confluent pathologies and risks of current treatments. Oral anticoagulation is recommended to reduce the risk of systemic thromboembolism in high-risk individuals with AF. The 'Watchman' device for left atrial appendage closure has shown comparable efficacy compared with anticoagulation with warfarin; however, patients with cancer were not included in trials testing Watchman safety and efficacy. We present the current treatment approaches for the management of AF in patients with malignancy. We review contemporary guidelines and propose a novel clinical decision tree by which physicians can consider left atrial appendage closure in cancer patients, and at last, suggest future investigation that might further clarify the clinical benefit of this approach.
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Affiliation(s)
| | - Ajay Bhandari
- Internal Medicine, University of South Florida, FL 33606, USA
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Pineda-Gayoso R, Alomar M, Lee DH, Fradley MG. Cardiovascular Toxicities of Bruton’s Tyrosine Kinase Inhibitors. Curr Treat Options Oncol 2020; 21:67. [DOI: 10.1007/s11864-020-00764-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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