Department of Internal Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, USA.
Division of Cardiology, University of Pittsburgh Medical Center, Harrisburg, PA, USA.
Postgrad Med. 2023 Aug;135(6):562-568. doi: 10.1080/00325481.2023.2218188. Epub 2023 May 29.
Atrial fibrillation (AF) is the most common arrhythmia in patients with cancer, especially breast, gastrointestinal, respiratory, urinary tract, and hematological malignancies. Catheter ablation (CA) is a well-established, safe treatment option in healthy patients; however, literature regarding safety of CA for AF in patients with cancer is limited and confined to single centers.
We aimed to assess the outcomes and peri-procedural safety of CA for AF in patients with certain types of cancer.
The NIS database was queried between 2016 and 2019 to identify primary hospitalizations with AF and CA. Hospitalizations with secondary diagnosis of atrial flutter and other arrhythmias were excluded. Propensity score matching was used to balance the covariates between cancer and non-cancer groups. Logistic regression was used to analyze the association.
During this period, 47,765 CA procedures were identified, out of which 750 (1.6%) hospitalizations had a diagnosis of cancer. After propensity matching, hospitalizations with cancer diagnosis had higher in-hospital mortality (OR 3.0, 95% CI 1.5-6.2, = 0.001), lower home discharge rates (OR 0.7, 95% CI 0.6-0.9, < 0.001) as well as other complications such as major bleeding (OR 1.8, 95% CI 1.3-2.7, = 0.001) and pulmonary embolism (OR 6.1, 95% CI 2.1-17.8, < 0.001) but not associated with any major cardiac complications (OR 1.2, 95% CI 0.7-1.8, = 0.53).
Patients with cancer who underwent CA for AF had significantly higher odds of in-hospital mortality, major bleeding, and pulmonary embolism. Further larger prospective observational studies are needed to validate these findings.
心房颤动（AF）是癌症患者中最常见的心律失常，尤其是乳腺癌、胃肠道癌、呼吸道癌、泌尿道癌和血液系统恶性肿瘤。导管消融（CA）是一种成熟且安全的治疗选择，适用于健康患者；然而，关于 CA 治疗癌症患者 AF 的安全性的文献有限，且仅限于单中心研究。
我们旨在评估 CA 治疗某些类型癌症患者 AF 的结局和围手术期安全性。
2016 年至 2019 年，我们对 NIS 数据库进行了查询，以确定 AF 和 CA 的首次住院治疗。排除了伴有心房扑动和其他心律失常的次要诊断的住院治疗。采用倾向评分匹配来平衡癌症组和非癌症组之间的协变量。采用逻辑回归分析相关性。
在此期间，共确定了 47765 例 CA 手术，其中 750 例（1.6%）住院诊断为癌症。经过倾向评分匹配后，癌症诊断组的住院患者死亡率更高（OR 3.0，95%CI 1.5-6.2，=0.001），出院回家率更低（OR 0.7，95%CI 0.6-0.9，<0.001），以及其他并发症发生率更高，如大出血（OR 1.8，95%CI 1.3-2.7，=0.001）和肺栓塞（OR 6.1，95%CI 2.1-17.8，<0.001），但与任何重大心脏并发症无关（OR 1.2，95%CI 0.7-1.8，=0.53）。
接受 CA 治疗 AF 的癌症患者住院期间死亡、大出血和肺栓塞的风险显著增加。需要进一步开展更大规模的前瞻性观察研究来验证这些发现。
