Outcomes for procedurally managed atrial arrhythmias in oncology patients referred through a regional cardio-oncology MDT

Atrial arrhythmias including atrial fibrillation (AF) commonly affect oncology patients; either as a pre-existing comorbidity, or a consequence of the malignancy or treatment and are associated with poorer outcomes (1). Decision-making on management, including rhythm control, is recommended to be carried out through a cardio-oncology multidisciplinary team (CO-MDT) (2). To date, however, there are scant data on the outcomes of patients referred for intervention through this pathway.

To investigate the outcomes of patients who were recommended by a regional CO-MDT for procedural intervention of atrial arrhythmias.

Retrospective analysis of cancer patients who were recommended procedural rhythm intervention for an atrial arrhythmia by a large multicentre CO-MDT between Jan 2022 and Dec 2024, reviewing electronic health records for baseline characteristics, medical history, and procedural details, outcomes and complications assessed to most recent follow up. Success assessed separately on i) maintenance of sinus rhythm, ii) improvement in symptoms, iii) improvement in left ventricular ejection fraction (LVEF) of >10% (if procedure indication heart failure with reduced ejection fraction (HFrEF). Complications defined as per UK National Audit of Cardiac Rhythm Management guidelines (3).

Out of 471 records screened, 14 patients were recommended for procedural rhythm intervention (median age 67.5 [interquartile range (IQR) 61-74], 57% male, 79% >2 cardiovascular comorbidities). 21% (n=3) of patients were pre-cancer treatment, 50% (n=7) had ongoing treatment, and 29% (n=4) had completed cancer treatment. Oncological diagnoses were varied (Table 1). All patients underwent their recommended procedure at median 44 [IQR 19-124] days post MDT. 57% (n=8) of procedures were ablations (3 AF, 4 flutter, 1 supra-ventricular ectopic) and 43% (n=6) direct current cardioversions (DCCV) for AF. In 50% of patients (n=7) the procedure was carried out for symptomatic relief, with additional indication of HFrEF in the remainder. At latest follow up (mean 386±213 days post procedure), sinus rhythm was maintained in 79% of patients (ablations=86%, DCCVs=66%) and symptoms improved in 64% (ablations=63%, DCCVs=66%). Where HFrEF was the procedure indication, 71% had stable improvement of LVEF >10% at mean 380±253 days post procedure, (mean LVEF pre-procedure 35%, mean LVEF post 46%, p<0.05)(Figure 1), enabling in 3 patients initiation of potentially cardiotoxic oncological treatment. There were no procedural complications found.

Patients referred for procedural rhythm intervention following CO-MDT discussion had no complications and high success rates despite being a heterogeneous multi-morbid patient group. A significant improvement in LVEF was seen in patients with HFrEF, in some cases allowing initiation of cancer treatment. CO-MDTs facilitate appropriate referral and management of atrial arrhythmias in oncology patients.Table 1  Figure 1