Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
Heart Health Research Center (HHRC), Beijing, China.
Pacing Clin Electrophysiol. 2023 Nov;46(11):1419-1429. doi: 10.1111/pace.14830. Epub 2023 Sep 22.
Cancer has become significant comorbidity in patients with atrial fibrillation (AF). However, little is known about the efficacy and safety of AF ablation, the first-line rhythm control strategy, in patients with cancer. This study aims to evaluate the incidence and risk of AF recurrence and safety endpoints in patients with cancer compared to the non-cancer group after ablation.
From August 2011 to December 2020, we consecutively enrolled cancer patients in the China-AF cohort. We used propensity score matching (1:3) to select the control group and assessed the risk of AF recurrence and adverse events after ablation in cancer patients using a multivariable Fine and Gray competing risk model.
A total of 203 patients with cancer were enrolled and 21 of them were active cancer, with a median follow-up of 12.3 months. The cumulative incidence of AF recurrence was comparable between patients with and without cancer (43.8% vs. 51.1%; p = .88). No difference in the risk of AF recurrence, thromboembolism, major bleeding, and mortality was observed after adjusting confounders. Active cancer was not associated with an increased risk of AF recurrence compared to the stable disease (SHR = 1.32; 95% CI 0.72-2.43; p = .46). Cancer was associated with a low risk of cardiovascular hospitalization (SHR, 0.54; 95% CI, 0.36-0.81; p = .01). Subgroup analysis found that hematological malignancy was associated with a high risk of AF recurrence (SHR, 5.68; 95% CI, 3.00-10.8; p < .001).
This study suggests that catheter ablation could be feasible for rhythm control of AF patients with concomitant cancer.
癌症已成为心房颤动（AF）患者的重要合并症。然而，对于癌症患者，作为一线节律控制策略的 AF 消融的疗效和安全性知之甚少。本研究旨在评估消融后与非癌症组相比，癌症患者的 AF 复发发生率和风险以及安全性终点。
从 2011 年 8 月至 2020 年 12 月，我们连续纳入中国 AF 队列中的癌症患者。我们使用倾向评分匹配（1：3）选择对照组，并使用多变量 Fine 和 Gray 竞争风险模型评估癌症患者消融后 AF 复发和不良事件的风险。
共纳入 203 例癌症患者，其中 21 例为活动性癌症，中位随访时间为 12.3 个月。有癌症和无癌症患者的 AF 复发累积发生率相当（43.8% vs. 51.1%；p=0.88）。在调整混杂因素后，AF 复发、血栓栓塞、大出血和死亡率的风险无差异。与稳定疾病相比，活动性癌症与 AF 复发风险增加无关（SHR=1.32；95%CI 0.72-2.43；p=0.46）。癌症与心血管住院风险降低相关（SHR，0.54；95%CI，0.36-0.81；p=0.01）。亚组分析发现，血液恶性肿瘤与 AF 复发风险增加相关（SHR，5.68；95%CI，3.00-10.8；p<0.001）。
本研究表明，导管消融可能对伴有癌症的 AF 患者的节律控制是可行的。
