Fonseca Marta, Cheng Evaline, Do Duc, Haldar Shouvik, Kutty Shelby, Yang Eric H, Ghosh Arjun K, Guha Avirup
Division of Cardiology, Cardiac-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital West Smithfield, London, United Kingdom.
Hatter Cardiovascular Institute, Institute of Cardiovascular Science UCL, University College London Hospital, London, United Kingdom.
South Asian J Cancer. 2021 Oct 15;10(3):195-210. doi: 10.1055/s-0041-1731907. eCollection 2021 Sep.
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.
缓慢性心律失常与癌症治疗之间的关系尚未得到充分描述，但越来越受到关注。肿瘤药物治疗取得了长足进展，有几种新型药物可供使用，包括靶向药物、免疫检查点抑制剂和嵌合抗原受体T细胞疗法。可用药物种类的不断增加彻底改变了癌症患者的总体预后和生存率，但其心血管毒性的真实程度才刚刚开始被了解。以往的研究和已发表的综述传统上主要关注传统化疗以及一般的心律失常，尤其是快速性心律失常。全球范围内患有癌症和心血管疾病的患者数量正在增加，肿瘤学家和心脏病学家需要善于处理心律失常相关情况。两个专业之间需要加强合作，包括开展心脏肿瘤学前瞻性数据收集研究，以填补这一领域的知识空白。本基于病例的综述总结了目前关于癌症治疗相关缓慢性心律失常发生率（包括其不同亚型）、可能机制和结果的现有证据。此外，我们提出了一个针对疑似与癌症治疗相关的缓慢性心律失常患者的逐步监测和管理方案。
