Arrhythmias in cancer: rhythm is gonna get you!

This article refers to ‘Ventricular tachycardia, premature ventricular contractions, and mortality in unselected patients with lung, colon, or pancreatic cancer: a prospective study’ by M.S. Anker et al., published this issue on pages 145–153. Cardiovascular (CV) disease is increasingly being recognized as an important part of the clinical spectrum cancer, representing second most common cause death these patients.1, 2 Coexisting CV disorders complications anticancer therapies may thus have impact outcomes patients, fact that gave rise concept new field Cardio-Oncology.3 Among manifestations malignancies, arrhythmias hold prominent position. Cancer develop wide range rhythm disorders, including either bradycardias conduction defects tachyarrhythmias such atrial fibrillation monomorphic polymorphic tachycardia.1, 4 Arrhythmias cancer result from interaction three main factors: patient's characteristics, therapy (Figure 1). Patient-related factors predispose include: (i) coexisting disease; (ii) ageing, denominator for both further, associated sick sinus syndrome; (iii) comorbid conditions diabetes mellitus chronic kidney (iv) genetic predisposition. Cancer, other hand, induce direct invasion heart primary cardiac neoplasm or, more often, metastatic tumour causing systemic abnormalities, autonomic nervous system derangement inflammation.4 Finally, contribute (e.g. chemotherapy, targeted therapies, immunotherapies), radiotherapy chest irradiation involving tissue supportive medications, antiemetics. Certain agents been pro-arrhythmic properties, QT prolongation typical one.5-7 Anticancer drugs further forms dysfunction failure myocardial ischaemia their cardiotoxicity profile inducing electrolyte metabolic due gastrointestinal toxicities. The role Cardio-Oncology specialist prevention management multiple concerns baseline assessment upon diagnosis, monitoring during active long-term surveillance survivors3, 8 2). Baseline evaluation aims at risk stratification identifying those who would require close after therapy, optimization therapies.9 In context, pre-existing arrhythmias, prolongation, inform special precautions even proper adaptations collaboration attending oncologist haematologist. During selected high-risk allow timely diagnosis among potential complications, although often be treated emergency setting. occurring follows general approach non-cancer but certain precautions. handling antiarrhythmics anticoagulants (in case fibrillation), requires careful drug interactions agents.10 Decision making interventions, device implantation, should also take under consideration prognosis malignancy life-expectancy patient. Anticoagulation challenging malignancies whom thromboembolic bleeding quite higher than patients.10 addition, adjustment ongoing required arrhythmia development. Long-term necessary survivors exposed significant cardiotoxic late cardiotoxicity. For example, degeneration fibrosis turn lead atrioventricular block several years radiotherapy.11 present Journal, colleagues report findings case-control study comparing between advanced healthy age- sex-matched controls.12 Patients had incidence non-sustained tachycardia (NSVT) ambulatory electrocardiographic monitoring. authors proposed perspective association beyond related therapy. On one they showed arrythmias bear prognostic significance found burden NSVT contractions predicted independently all-cause mortality. Similarly, previous studies shown fibrillation, if transient stressors surgery, independent predictor worse malignancies.4 Beyond make step forward, suggesting represent therapeutic target cardioactive medications mitigating arrhythmias. Although latter remains hypothesis needs investigated consider type stage, it stresses importance addressing cancer. It has previously well-structured assessment, stratification, renders majority them fit receive best available without interruptions,13 which increases possibility favourable outcome. treatment toxicity improves patients' survival.14 Further improvements are expected accomplished research provides solid evidence when well established. All activities constitute framework comprehensive service. Conflict interest: D.F. received consultation fees and/or speaker honoraria Abbott Laboratories, Bayer, Boehringer Ingelheim, Leo, Menarini, Novartis, Orion Pharma Roche Diagnostics. G.F. served member committees trials sponsored Amgen, Medtronic, Servier Vifor.