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Efficacy and safety of catheter ablation for atrial fibrillation in patients with history of cancer

Cardio-Oncology volume 9, Article number: 19 (2023) Cite this article

Abstract

Background

Though the incidence of atrial fibrillation (AF) is increased in patients with cancer, the effectiveness of catheter ablation (CA) for AF in patients with cancer is not well studied.

Methods

We conducted a retrospective cohort study of patients who underwent CA for AF. Patients with a history of cancer within 5-years prior to, or those with an exposure to anthracyclines and/or thoracic radiation at any time prior to the index ablation were compared to patients without a history of cancer who underwent AF ablation. The primary outcome was freedom from AF [with or without anti-arrhythmic drugs (AADs), or need for repeat CA at 12-months post-ablation]. Secondary endpoints included freedom from AF at 12 months post-ablation with AADs and without AADs. Safety endpoints included bleeding, pulmonary vein stenosis, stroke, and cardiac tamponade. Multivariable regression analysis was performed to identify independent risk predictors of the primary outcome.

Results

Among 502 patients included in the study, 251 (50%) had a history of cancer. Freedom from AF at 12 months did not differ between patients with and without cancer (83.3% vs 72.5%, p 0.28). The need for repeat ablation was also similar between groups (20.7% vs 27.5%, p 0.29). Multivariable regression analysis did not identify a history of cancer or cancer-related therapy as independent predictors of recurrent AF after ablation. There was no difference in safety endpoints between groups.

Conclusion

CA is a safe and effective treatment for AF in patients with a history of cancer and those with exposure to potentially cardiotoxic therapy.

Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting 1.5–2% of the general population [1]. The incidence of AF is increased in patients with cancer (up to 20%), particularly among those with advanced age or pre-existing cardiovascular risk factors [2,3,4,5]. Postulated mechanisms include atrial remodelling due to a pro-inflammatory state, dysautonomia, paraneoplastic processes, electrolyte abnormalities and direct myocardial damage either due to cancer therapies, surgery or less commonly, metastatic invasion of pulmonary, pericardial and myocardial tissues [6,7,8,9]. Certain cancer therapies like Bruton’s tyrosine kinase inhibitors [10], anthracyclines, immune checkpoint inhibitors, antimetabolites, and alkylating agents are associated with a higher incidence of AF [9].

While the presence of AF does not preclude cancer therapy, downstream complications such as thromboembolic events and the development of heart failure (HF) can lead to increased morbidity and mortality in patients with cancer [11]. For example, patients with cancer and AF have a sixfold increased risk of HF and twofold higher risk of stroke compared to the general population [11,12,13].

In the general population, rhythm control is recommended in patients who are symptomatic despite adequate rate control and in patients with HF [14,15,16,17] However, there are several unique considerations for rhythm control in patients with cancer. The co-administration of anti-arrhythmic drugs (AADs) and targeted cancer therapies, especially, tyrosine kinase inhibitors (TKIs), can lead to increased concentrations of either drug, via impaired cytochrome P-450 metabolism or inhibition of P-glycoprotein-mediated transport [18]. An increased propensity for QT prolongation and bradycardia is also present, further limiting the use of AADs in patients with cancer [18].

Catheter ablation for AF is an established treatment modality with relatively high success rates and few procedural complications [19]. Growing evidence demonstrates that catheter ablation for AF in patients with HF is associated with improved clinical outcomes and quality of life compared to medical therapy alone [15]. Patients with cancer, particularly those exposed to potentially cardiotoxic antineoplastic therapies, are at a higher risk of developing AF and subsequent cardiomyopathy and HF and catheter ablation may provide a promising treatment option for selected patients. In addition to symptomatic improvement, catheter ablation may alleviate the need for ongoing AAD therapy thus limiting serious drug-drug interactions. However, catheter ablation for AF may be underutilized in patients with cancer due to a concern for lower success rates attributed to the underlying inflammatory state, continued exposure to potentially cardiotoxic and proarrhythmic agents, and a perceived risk of higher complication rates with invasive therapies in this patient population. In this study, we sought to explore the efficacy and safety of catheter ablation for AF in patients with cancer.

Methods

Study oversight

This study was approved by the Institutional Review Boards (IRB) of Lahey Hospital & Medical Center, Beth Israel Deaconess Medical Center, and Brigham and Women’s Hospital. The need for written informed consent was waived by the IRB. All authors reviewed the manuscript and attest to the integrity, accuracy, and completeness of the data.

Study population and design

This was a retrospective cohort study of consecutive patients who underwent catheter ablation for AF between January 1, 2014 and December 31, 2018. The cohort of interest included patients ≥ 18 years of age, with either active cancer, a history of malignancy 5-years prior to the index ablation procedure, or those with exposure to systemic anthracyclines and/or thoracic radiation therapy any time before the index ablation. Patients with non-melanotic skin cancers were excluded. The control group consisted of an equivalent number of consecutive patients without a current or prior history of cancer who underwent catheter ablation for AF at Lahey Hospital & Medical Center. The patients in the control arm were selected from the more contemporary period of the study till we had sufficient numbers matching the cases. Patients with paroxysmal, persistent, and long-standing persistent AF were included. Patients with valvular AF were excluded.

Data acquisition

Patient demographics and comorbidities (age, gender, body mass index, smoking history, hypertension, hyperlipidemia, diabetes, obstructive sleep apnea, obstructive coronary artery disease, presence of more than mild valvular heart disease, HF and prior stroke or transient ischemic attack (TIA)) were extracted from the electronic medical record. We also collected data regarding medications used for the management of AF prior to ablation, prior cardioversions, left atrial diameter prior to ablation, and type and modality of ablation. Cancer-specific characteristics such as type of malignancy, presence of metastatic disease, active cancer therapy, systemic chemotherapy or surgery in the 5 years prior to ablation, radiation therapy, anthracycline exposure, cancer status at the time of ablation, and cancer recurrence after ablation were also obtained. The CHA2DS2-VASc score was used to calculate stroke risk. Anticoagulation with either warfarin or direct oral anticoagulants (DOACs) was also recorded.

Study endpoints

The primary outcome was freedom from AF [with or without anti-arrhythmic drugs (AADs), or need for repeat CA] at 12-months post-ablation in patients with a history of cancer compared to controls. The secondary endpoints included freedom from AF with, and without AADs at 12 months post-ablation. Safety endpoints assessed peri-procedural complications including bleeding requiring investigation or intervention or transfusion (access and non-access site), pulmonary vein stenosis, stroke, and cardiac tamponade within the first 3 months after ablation. The outcomes were documented through detailed chart review in the electronic health record system.

Statistical analysis

Categorical data are presented as numbers and percentages, and continuous variables as mean ± standard deviation (SD) or median and interquartile range (IQR). Baseline characteristics and outcomes after catheter ablation for AF were compared between patients with cancer and controls. Student’s t test, Wilcoxon rank-sum test, and chi-squared test or Fisher’s exact test were utilized to compare continuous non-skewed, skewed, and categorical variables, respectively. Multivaribale regression analyses were used to determine adjusted odds ratios and predictors of AF recurrence in patients who underwent catheter ablation. All variables with a p value < 0.1 in the univariable analyses, with less than 20% of missingness, were included in the multivariable analyses, after assessing for collinearity. Clinically relevant variables deterimed after review of the prior literuature were also included in the multivariable model and the performance of the model was assessed using the Akaike information criterion (AIC). To assess for collinearity, variance inflation factor (VIF) values were calculated for each predictor variable. Values of VIF exceeding 2.5 were viewed as being indicative of high correlation. Our analysis revealed a VIF range from of 1.19- 2.36. The final estimates were not disproportionately skewed by collinearity among predictors. Results were reported as odds ratios (OR) with 95% confidence intervals (CI). Kaplan–Meier survival curves were used to depict outcomes in patients with and without cancer and were compared using log-rank tests. A two-sided p value < 0.05 was considered statistically significant. Data analysis was performed using R version 4.0.3.

Results

Patient population

The study cohort included 502 patients who underwent catheter ablation for AF. Among these 251 (50%) had a history of cancer (Fig. 1).

Fig. 1
figure 1

Efficacy and Safety of Catheter Ablation for Atrial Fibrillation in Patients with History of Cancer

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Patient characteristics

Patients with cancer were significantly older than those without cancer (67 vs. 64 years, p < 0.01). Sex was balanced between the two groups with 47% females in the cancer group and 42.6% in the non-cancer group (p = 0.32). The prevalence of comorbidities including hypertension, diabetes, tobacco use, obstructive sleep apnea, coronary artery disease, valvular heart disease, congestive heart failure, and prior stroke or TIA was similar in both groups. Hyperlipidemia was significantly more common in patients with cancer compared to controls (57% vs 44.6%, p = 0.006). There was no difference in overall functional status between the 2 groups (p = 0.23) with more than half the patients in each group being categorized as NYHA class 1 (Table 1).

Table 1 Baseline Characteristics of patients treated with catheter ablation for atrial fibrillation
Full size table

The majority of the patients had a diagnosis of paroxysmal AF in both the cancer and controls groups (54.2% vs. 56.2%). Beta blockers were administered equally in those with and without cancer (74.5% vs 70.5%, p = 0.32). The most common antiarrhythmic drug utilized in the entire cohort was sotalol (31.2% of cancer patients vs. 27.1% of controls, p = 0.32). Amiodarone was used more frequently in cancer patients compared to controls (30.7% vs 15.9%, p < 0.001). There was no difference between groups in the utilization of other AADs (Table 1). Cardioversion was attempted prior to ablation in 60.2% of patients with cancer and in 57.8% of those without cancer (p = 0.59). The average CHA2DS2-VASc score in both groups was 2. The majority of patients were on DOACs (56.2% in the cancer group vs. 58.2% in the non-cancer group, p = 0.33). In contrast, warfarin use was significantly higher among cancer patients compared to controls (41.8% vs 27.5%, p = 0.002) (Table 1).

Procedural characteristics

There were significant differences between the groups in terms of type and modality of catheter ablation. Radiofrequency ablation was employed more frequently in patients with cancer (58.2% vs. 8.4%, p < 0.001). In contrast, cryoablation was used more frequently in controls (53.4% vs 36.2%, p < 0.001). The combination of both modalities was also utilized more frequently in controls (38.3% vs 5.6%, p < 0.001). Adjuvant substrate modification with linear ablations in addition to pulmonary vein isolation was performed more frequently in patients with cancer compared to controls (54.6% vs 38.6%, p < 0.001) (Table 1).

Cancer characteristics

Among those with cancer, breast cancer was the most common diagnosis (n = 50, 19.9%). Other prevalent cancers included prostate cancer (n = 33, 13.1%), lymphoma (n = 20, 8%) and lung cancer (n = 12, 4.8%). A total of 28 (11.2%) patients had metastatic disease and 33 (13.1%) patients had a history of multiple malignancies. Among patients with cancer, 46 (18.3%) were undergoing active treatment and 205 (81.7%) were in remission at the time of catheter ablation. Systemic chemotherapy was administered in 80 (31.9%) patients and surgery for resection of cancer was performed in 114 (45.4%) patients within the 5 years prior to the index ablation. Anthracyclines were utilized in 41 (15.3%) patients. Radiation to the left lung and left breast were performed in 2% and 15.9% of patients, respectively. A total of 11 (4.4%) patients had recurrence of cancer within a year after catheter ablation (Table 1).

Outcomes

Primary and secondary outcomes

There was no significant difference in the primary outcome of freedom from AF, with or without AADs, or need for repeat ablation at 12 months post-ablation between those with and without cancer (83.3% vs 72.5%, p = 0.28) (Table 2) (Fig. 2).

Table 2 Outcomes after catheter ablation in patients with and without cancer
Full size table
Fig. 2
figure 2

Kaplan–Meier survival curve showing freedom from recurrent atrial fibrillation and need for repeat ablation. There was no significant difference in the freedom from recurrent atrial fibrillation or need for repeat ablation between patients with cancer (green) and non-cancer controls (red) (HR 0.92, 95% CI 0.52–1.62, p = 0.77). NSR = normal sinus rhythm

Full size image

The secondary outcome of freedom from AF without AADs at 12 months was higher in patients with cancer than controls (50.6% vs 35%, p < 0.001). In contrast, freedom from AF with AADs at 12 months did not differ between groups (Table 2). The odds of recurrent AF after three, six, nine, and twelve months from the index ablation were similar between groups even after adjusting for multiple clinical covariates and modality of ablation (Table 3). The need for repeat ablation did not differ between the two groups (20.7% of cancer patients vs 27.5% of non-cancer patients, p = 0.29). Post-ablation left ventricular ejection fraction was also similar in the cancer and non-cancer groups (60% vs 57%, p = 0.31).

Table 3 Adjusted odds ratios for recurrence of atrial fibrillation in patients with cancer compared with non-cancer controls
Full size table

In the entire cohort of patients, obesity (increased BMI) was identified as a significant predictor of recurrent AF after the 3-month post-ablation blanking period with OR 1.07 (95% CI 1.03–1.11, p < 0.001) (Table 4). In patients with cancer, increased BMI was also identified as significant predictor of recurrent AF after the 3-month post-ablation blanking period (OR 1.08, 95% CI 1.03–1.15, p = 0.002) (Table 5).

Table 4 Multivariable regression analysis of the entire study cohort to identify predictors of recurrent atrial fibrillation after a 90-day blanking period
Full size table
Table 5 Multivariable regression analysis of patients with cancer to identify predictors of recurrent atrial fibrillation after a 90-day blanking period
Full size table

Safety outcomes

There was no statistical difference in the incidence of complications within the first 3 months post-ablation, including access and non-access site bleeding, pulmonary vein stenosis, stroke, and cardiac tamponade, between the cancer and non-cancer groups (Table 2).

Discussion

The results of this study demonstrate that catheter ablation is an effective and safe modality for treating AF in selected patients with cancer. The success rate, defined as freedom from recurrent AF, with or without AAD, and need for repeat ablation at 12 months post-ablation, in patients with cancer was similar to that observed in non-cancer controls. At the same time, safety outcomes, including post-procedural bleeding, pulmonary vein stenosis, stroke, and cardiac tamponade within the first 3 months after catheter ablation, were also similar to non-cancer controls.

There is limited data evaluating the effectiveness and safety of catheter ablation for AF in patients with cancer. A prior propensity-matched cohort study evaluated the effectiveness and safety of cryoablation for AF in 70 patients with cancer and 70 non-cancer controls [20]. In this study, arrhythmia free survival at 12 months did not differ significantly between patients with cancer and controls (67.1 ± 5.8% vs. 77.8 ± 5.1%, p = 0.16). Our results agree with and add to the results of this prior study. Importantly, compared to this prior study, our study included a larger number of patients, more patients with active cancer, and both radiofrequency and cryoablation procedures.

The safety of catheter ablation for AF in patients with cancer has been evaluated in 2 prior studies. Eitel et al. evaluated safety outcomes including the development of phrenic nerve palsy, femoral pseudoaneurysms, peri-procedural bleeding, cardiac tamponade, and death and found no difference between cancer and non-cancer patients [20]. In contrast, Giustozzi et al. found a significantly higher risk of clinically relevant bleeding within 1 month after catheter ablation in 21 patients with cancer compared to 163 non-cancer controls [21]. A potential reason for the excess bleeding risk observed by Giustozzi et al. includes their practice of bridging with low molecular weight heparin after the procedure rather than continuing anticoagulation without interruption, as is the usual practice at the institutions included in our study. Furthermore, more than half the patients included in the study by Giustozzi et al. had a history of gastrointestinal and genitourinary malignancies that are more prone to bleeding with anticoagulation than other cancers [22].

In our study, radiofrequency ablation was used more frequently in patients with cancer, while cryoablation was used more commonly in controls. While we do not have data to explain the rationale behind this discrepancy, one possible explanation may be the reduced fluoroscopic exposure with radiofrequency ablation compared to cryoablation. However, both techniques have been shown to be equally efficacious and safe in randomized clinical trials and therefore, it is not surprising that outcomes were similar between cancer and non-cancer controls in our cohort [23]. Additionally, we performed multivariate regression analysis and the type of ablation performed was not identified as a significant predictor of outcomes.

We used multivariable analysis to identify potential predictors of recurrent AF after a 90-day blanking period in patients with and without cancer. BMI was identified as a significant predictor in both groups (Fig. 1). This result is not surprising since obesity has been associated with an increased risk of recurrent AF after ablation in prior studies [24, 25]. Moreover, it has been shown that 10% or more weight loss prior to ablation or bariatric surgery prior to ablation, are both associated with a significant reduction in the risk of recurrent AF [26, 27].

Thoracic radiation therapy for cancer has been postulated to promote inflammation and tissue fibrosis, potentially leading to an increased risk of recurrent AF after ablation. Prior studies have had conflicting results regarding the impact of thoracic radiation therapy for cancer on left atrial scar volume. One study of 7 cancer patients (6 lymphoma and 1 esophageal cancer) treated with thoracic radiation demonstrated a linear relationship between mean cardiac radiation dose and left atrial scar volume on cardiac magnetic resonance imaging [28]. In contrast, another study comparing 38 patients with breast cancer to non-cancer controls did not find any difference in LA scar volumes during electrophysiology mapping [29]. Interestingly, our results did not identify left sided radiation as a significant predictor of recurrent AF in patients with cancer. Similarly, Etial et al. found that arrhythmia-free survival was not reduced in patients with a history of thoracic radiation relative those who did not receive thoracic radiation [20].

Our study has several limitations. Given that this was a retrospective cohort study, we cannot rule out the possibility of selection bias among patients referred for ablation. While this is the largest cohort study to date of cancer patients undergoing catheter ablation for AF, the number of patients is still relatively low, with a small proportion of patients with active cancer (18.3%). Therefore, the true impact of active cancer therapy on the effectiveness, and more importantly, safety of catheter ablation may not be accurately assessed in this study. The types of cancer and cancer therapies were also heterogeneous in our study and further studies are needed to evaluate the effectiveness of catheter ablation for certain cancer therapies, such as Bruton’s tyrosine kinase inhibitors, that are associated with a higher risk of AF. A relatively small number of patients (32%) had received systemic antineoplastic therapy, and only 16% had received anthracyclines. Although given the overall small sample size, a subgroup analysis could not be performed, a multivariable regression analysis of patients with cancer does not identify anthracycline exposure as an independent predictor of AF recurrence. While we have determined the inclusion criteria based on our understanding of the immediate cardiovascular outcomes for patients undergoing cancer treatment and based on the long-term adverse effects of anthracyclines and thoracic radiation therapy, it is important to note that these are somewhat arbitrary and, our knowledge is evolving, especially regarding the novel agents which may be associated with long-term arrhythmogenic effects and our analysis may not account for such effects.

In conclusion, the results of our retrospective cohort study demonstrate that catheter ablation for AF is effective and safe in patients with cancer. The outcomes observed in cancer patients are similar to those seen in patients without cancer, supporting the recommendation that ablation should be offered as a therapeutic modality to treat AF in selected patients with cancer.

Availability of data and materials

Aggregate de-identified data can be made available on request.

References

  1. Paterson DI, Wiebe N, Cheung WY, et al. Incident cardiovascular disease among adults with cancer. JACC CardioOncol. 2022;4(1):85–94.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. developed with the special contribution of the European heart rhythm association. Eur Heart J. 2012;33(21):2719–47.

    Article  PubMed  Google Scholar 

  3. Chu G, Versteeg HH, Verschoor AJ, et al. Atrial fibrillation and cancer – an unexplored field in cardiovascular oncology. Blood Rev. 2019;35:59–67.

    Article  PubMed  Google Scholar 

  4. Menichelli D, Vicario T, Ameri P, et al. Cancer and atrial fibrillation: epidemiology, mechanisms, and anticoagulation treatment. Prog Cardiovasc Dis. 2021;66:28–36.

    Article  PubMed  Google Scholar 

  5. Erichsen R, Christiansen CF, Mehnert F, Weiss NS, Baron JA, Sørensen HT. Colorectal cancer and risk of atrial fibrillation and flutter: a population-based case–control study. Intern Emerg Med. 2012;7(5):431–8.

    Article  PubMed  Google Scholar 

  6. Leiva O, AbdelHameid D, Connors JM, Cannon CP, Bhatt DL. Common pathophysiology in cancer, atrial fibrillation, atherosclerosis, and thrombosis. JACC CardioOncol. 2021;3(5):619–34.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Farmakis D, Parissis J, Filippatos G. Insights into onco-cardiology: atrial fibrillation in cancer. J Am Coll Cardiol. 2014;63(10):945–53.

    Article  PubMed  Google Scholar 

  8. Onaitis M, D’Amico T, Zhao Y, O’Brien S, Harpole D. Risk factors for atrial fibrillation after lung cancer surgery: analysis of the society of thoracic surgeons general thoracic surgery database. Ann Thorac Surg. 2010;90(2):368–74.

    Article  PubMed  Google Scholar 

  9. Mosarla RC, Vaduganathan M, Qamar A, Moslehi J, Piazza G, Giugliano RP. Anticoagulation strategies in patients with cancer. J Am Coll Cardiol. 2019;73(11):1336–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ganatra S, Sharma A, Shah S, et al. Ibrutinib-associated atrial fibrillation. JACC Clin Electrophysiol. 2018;4(12):1491–500.

    Article  PubMed  Google Scholar 

  11. Hu Y-f, Liu C-j, Chang PM-h, et al. Incident thromboembolism and heart failure associated with new-onset atrial fibrillation in cancer patients. Int J Cardiol. 2013;165(2):355–7.

    Article  PubMed  Google Scholar 

  12. López-Fernández T, Martín-García A, Roldán Rabadán I, et al. Atrial fibrillation in active cancer patients: expert position paper and recommendations. Rev Esp Cardiol (Engl Ed). 2019;72(9):749–59.

    Article  PubMed  Google Scholar 

  13. Kamphuisen PW, Beyer-Westendorf J. Bleeding complications during anticoagulant treatment in patients with cancer. Thromb Res. 2014;133:S49–55.

    Article  CAS  PubMed  Google Scholar 

  14. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons. Circulation. 2019;140(2):e125–51.

    Article  PubMed  Google Scholar 

  15. Marrouche NF, Brachmann J, Andresen D, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417–27.

    Article  PubMed  Google Scholar 

  16. Rillig A, Magnussen C, Ozga AK, et al. Early rhythm control therapy in patients with atrial fibrillation and heart failure. Circulation. 2021;144(11):845–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Di Biase L, Mohanty P, Mohanty S, et al. Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results From the AATAC multicenter randomized trial. Circulation. 2016;133(17):1637–44.

    Article  PubMed  Google Scholar 

  18. Asnani A, Manning A, Mansour M, Ruskin J, Hochberg EP, Ptaszek LM. Management of atrial fibrillation in patients taking targeted cancer therapies. Cardio-Oncology. 2017;3(1):2.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nat Rev Cardiol. 2021;18(3):210–25. https://doi.org/10.1038/s41569-020-00451-x.

    Article  PubMed  Google Scholar 

  20. Eitel C, Sciacca V, Bartels N, Saraei R, Fink T, Keelani A, Gaßmann A, Kuck K-H, Vogler J, Heeger C-H, Tilz RR. Safety and efficacy of cryoballoon based pulmonary vein isolation in patients with atrial fibrillation and a history of cancer. J Clin Med. 2021;10(16):3669. https://doi.org/10.3390/jcm10163669.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Giustozzi M, Ali H, Reboldi G, et al. Safety of catheter ablation of atrial fibrillation in cancer survivors. J Interv Card Electrophysiol. 2021;60:419–26. https://doi.org/10.1007/s10840-020-00745-7.

    Article  PubMed  Google Scholar 

  22. Costa OS, Kohn CG, Kuderer NM, Lyman GH, Bunz TJ, Coleman CI. Effectiveness and safety of rivaroxaban compared with low-molecular-weight heparin in cancer-associated thromboembolism. Blood Adv. 2020;4(17):4045–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Andrade JG, Champagne J, Dubuc M, et al. Cryoballoon or radiofrequency ablation for atrial fibrillation assessed by continuous monitoring: a randomized clinical trial. Circulation. 2019;140(22):1779–88. https://doi.org/10.1161/CIRCULATIONAHA.119.042622.

    Article  PubMed  Google Scholar 

  24. Sivasambu B, Balouch MA, Zghaib T, et al. Increased rates of atrial fibrillation recurrence following pulmonary vein isolation in overweight and obese patients. J Cardiovasc Electrophysiol. 2018;29:239–45. https://doi.org/10.1111/jce.13388.

    Article  PubMed  Google Scholar 

  25. Glover BM, Hong KL, Dagres N, et al. Impact of body mass index on the outcome of catheter ablation of atrial fibrillation. Heart. 2019;105(3):244–50. https://doi.org/10.1136/heartjnl-2018-313490.

    Article  PubMed  Google Scholar 

  26. Pathak RK, Middeldorp ME, Meredith M, et al. Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY). J Am Coll Cardiol. 2015;65(20):2159–69. https://doi.org/10.1016/j.jacc.2015.03.002.

    Article  PubMed  Google Scholar 

  27. Donnellan E, Wazni O, Kanj M, et al. Outcomes of atrial fibrillation ablation in morbidly obese patients following bariatric surgery compared with a nonobese cohort. Circ Arrhythmia Electrophysiol. 2019;12(10):e007598.

    Article  Google Scholar 

  28. Huang YJ, Harrison A, Sarkar V, et al. Detection of late radiation damage on left atrial fibrosis using cardiac late gadolinium enhancement magnetic resonance imaging. Adv Radiat Oncol. 2016;1(2):106–114. Published 2016 Apr 26. doi:https://doi.org/10.1016/j.adro.2016.04.002.

  29. Hashiguchi N, Schenker N, Rottner L, Reißmann B, Rillig A, Maurer T, Lemes C, Kuck K-H, Ouyang F, Mathew S. Absence of detectable effect of radiotherapy and chemotherapy for breast cancer on the presence of low voltage areas in patients receiving left atrial catheter ablation. Acta Cardiol. 2021;76(10):1061–8. https://doi.org/10.1080/00015385.2020.1812892.

    Article  PubMed  Google Scholar 

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Funding

Not applicable as no funding was obtained for this study.

Author information

Authors and Affiliations

  1. Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, 41 Mall Road, Burlington, Burlington, MA, 01805, USA

    Sarju Ganatra, Sonu Abraham, Rohan Parikh, Rushin Patel, Sumanth Khadke & Sourbha S. Dani

  2. Department of Medicine, Cleveland Clinic Akron General, Akron, OH, USA

    Ashish Kumar

  3. Cardio-Oncology Program, Department of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Amudha Kumar, Victor Liu, Andrea Nathalie Rosas Diaz & Aarti Asnani

  4. Cardiovascular Imaging Research Center (CIRC) and Cardio-Oncology Program, Massachusetts General Hospital, Boston, MA, USA

    Tomas G. Neilan

  5. Division of Cardiovascular Medicine, Department of Medicine, Electrophysiology Program, Lahey Hospital & Medical Center, Burlington, MA, USA

    Bruce Hook

  6. Department of Cardiovascular Medicine, Electrophysiology Program, Brigham and Women’s Hospital, Boston, MA, USA

    David Martin

  7. Cardio-Oncology Program, Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Anju Nohria

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  1. Sarju Ganatra
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  2. Sonu Abraham
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Contributions

The study design was formulated by Sarju Ganatra and Anju Nohria. The data was collected by Sonu Abraham, Rohan Parikh, Rushin Patel, Amudha Kumar, Victor Liu and Andrea Nathalie Rosas Diaz. Data analysis was performed by Ashish Kumar, Sourbha Dani, Sarju Ganatra and Anju Nohria. The figures were prepared by Sonu Abraham, Ashish Kumar and Sarju Ganatra. All the authors were involved in the preparation and review of the manuscript. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Sarju Ganatra.

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Ethics approval and consent to participate

The study was approved by the Internal Review Boards of Lahey Hospital & Medical Center, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center.

Competing interests

Dr. Nohria is supported by the Catherine Fitch Fund and the Gelb Master Clinician Fund at Brigham and Women’s Hospital. Dr. Neilan has the following disclosures: Consultancy: Intrinsic Imaging, Bristol Myers Squibb, AbbVie, Genentech, Roche, Sanofi, C-4 Therapeutics, CRO Oncology, Amgen. Grant Funding: AstraZeneca, Bristol Myers Squibb.

The remaining authors have nothing to disclose.

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Ganatra, S., Abraham, S., Kumar, A. et al. Efficacy and safety of catheter ablation for atrial fibrillation in patients with history of cancer. Cardio-Oncology 9, 19 (2023). https://doi.org/10.1186/s40959-023-00171-4

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  • DOI: https://doi.org/10.1186/s40959-023-00171-4

Cardio-Oncology

ISSN: 2057-3804

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