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Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis

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Abstract

Background

Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients with versus without prior or active cancer.

Methods

We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of CA for AF in cancer survivors. Outcomes of interest were bleeding events, late AF recurrence, and need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints.

Results

We included 5 retrospective cohort studies comprising 998 patients, of whom 41.4% had a history of cancer. Cancer survivors were at significantly higher risk of clinically relevant bleeding (OR 2.17; 95% CI 1.17-4.0; p=0.01) as compared with those without cancer. The efficacy of CA for AF was similar between groups. Late AF recurrence at 12 months was not significantly different between patients with vs. without a history of cancer (OR 1.29; 95% CI 0.78–2.13; p=0.32). Similar findings were observed in the outcome of repeat ablations (OR 0.71; 95% CI 0.37-1.37; p=0.31).

Conclusions

These findings suggest that cancer survivors have an increased risk of bleeding after CA for AF relative to patients without cancer, with no significant difference in the efficacy of CA for maintenance of sinus rhythm between groups.

Study registration

This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023394538.

Graphical abstract

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Data availability

This meta-analysis was based on data extracted from previously published research; therefore, all the data and study materials are available in the public domain. The authors of this meta-analysis do not have access to patient-level data of the individual studies. Researchers interested in individual-level data from the studies included in this meta-analysis are encouraged to contact the corresponding author from each individual study for such requests.

Abbreviations

AAD:

Antiarrhythmic drug

AF:

Atrial fibrillation

CI:

Confidence intervals

CRNMB:

Clinically relevant non-major bleeding

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

PROSPERO:

International Prospective Register of Systematic Reviews

QUIPS:

Quality in Prognostic Studies

OR:

Odds ratio

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Acknowledgements

The authors thank Dr. Roberta Florido, director of Cardio-Oncology at the University of Utah, for her review of the abstract of this manuscript, presented at the 2023 American Heart Association Scientific Sessions. The authors also thank Dr. Rhanderson Cardoso, from the Heart and Vascular Center at Brigham and Women’s Hospital, Harvard Medical School, for his expertise and guidance in the review of our research. A portion of this work has been previously presented as an abstract at the 2023 American Heart Association Scientific Sessions.

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Authors and Affiliations

  1. School of Medicine, Federal University of Ceará, Ceara, Fortaleza, Brazil

    Thomaz Alexandre Costa

  2. Federal University of Campina Grande, Campina Grande, Paraiba, Brazil

    Nicole Felix & Larissa Teixeira

  3. Faculdade de Medicina de Petrópolis, Petrópolis, Rio de Janeiro, Brazil

    Mariana Clemente

  4. Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Marcelo Antonio Pinheiro Braga

  5. Dante Pazzanese Institute of Cardiology, São Paulo, Brazil

    Livia Teixeira Martins Silva

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Contributions

TAC: conceptualization, study design, data collection, data analysis, data interpretation, writing (original draft), writing (review and editing); NF: conceptualization, study design, data collection, data analysis, data interpretation, writing (original draft), writing (review and editing); MC: data collection, data analysis, writing (original draft); LT: data collection, data analysis, writing (original draft); MAPB: data collection, data analysis, writing (original draft); LTMS: conceptualization, data interpretation, writing (original draft), writing (review and editing).

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Correspondence to Thomaz Alexandre Costa.

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The authors declare no competing interests. Author L.T.M.S. is currently an Editorial Training Fellow at the Journal of Interventional Cardiac Electrophysiology.

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Costa, T.A., Felix, N., Clemente, M. et al. Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis. J Interv Card Electrophysiol 67, 211–219 (2024). https://doi.org/10.1007/s10840-023-01677-8

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