scholarly journals Atrial Fibrillation in Cancer Patients: Who is at Risk?

2022 ◽  
Vol 17 (6) ◽  
pp. 900-907
Author(s):  
Yu. A. Vasyuk ◽  
E. Yu. Shupenina ◽  
D. A. Vyzhigin ◽  
E. O. Novosel ◽  
K. V. Gallinger

Cancer is the second leading cause of mortality in the world, second only to cardiovascular diseases. Simultaneously cancer mortality has been steadily decreasing due to the development  of new chemotherapy and targeted  drugs  and the improvement  of existing  treatment protocols.  Improving the prognosis of treatment of cancer patients leads to an unexpected  result - more patients are faced with side effects of cancer treatment. Cardiotoxicity, including  arrhythmia, has  become  a significant  factor  to reduce  the effectiveness  of cancer  patient’s  treatment.  Atrial  fibrillation  is frequent  and persistent a rhythm disorder, affecting  all categories  of patients, especially the elderly. An association  between these two conditions  can be expected, considering the fact that in old age the prevalence of malignant neoplasms  and comorbid pathology predisposing to the onset of AF is high. Therefore, AF may be an additional  factor negatively  influencing the prognosis and treatment tactics in patients with malignant neoplasms. A comprehensive search was conducted  using the keywords  “cancer”, “atrial fibrillation” and “cardiotoxicity” using the PubMed,  Scopus and Cohrane  databases. We reviewed publications having the relationship between AF and cancer. The literature review considered 61 publications on the prevalence of AF in cancer patients, classification, mechanisms of development, the effect of anticancer drugs and other treatment methods on this group of patients. Analyzed articles include clinical guidelines, consensus  expert opinions,  systematic  reviews,  meta-analyzes, and previously  published  reviews of the literature. The problem of cardiotoxic  complications diagnostics is evaluated separately,  incl. arrhythmias, and their monitoring in cancer patients. Therefore, the direction of medicine named "Cardio-oncology" comes to the fore. Interdisciplinary interaction will allow identify cardiotoxic  manifestations at the subclinical stage and optimize anticancer treatment.

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.S Yang ◽  
M Shim ◽  
S.H Kang ◽  
S.H Kim ◽  
W.J Kim ◽  
...  

Abstract Background and objectives The prevalence of both atrial fibrillation (AF) and cancer are increasing especially in the elderly. The occurrence of AF in cancer may be related to comorbidities of patients, cancer treatment, or a direct tumor effect. The objectives of this study were to investigate the incidence of AF according to cancer type. Methods From the Korean National Health Insurance Service elderly (NHIS-elderly) cohort (age >60), we identified 67,077 patients with newly diagnosed cancer and without previous AF. Incidence rates of new onset AF were evaluated. Results The mean age of the cancer patients was 75.1 year and 53.5% were males. During a median follow-up period of 25 months, the incidence rate of AF among overall cancer patients was higher than that of age-sex matched non-cancer population (1.42 vs. 0.69 per 100 person-years, respectively). Compared with solid cancer, the risk of incident AF in patients with hematologic cancer was significantly higher (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.39–1.72, p<0.001). Among patients with solid cancer, thoracic (lung cancer, esophageal cancer, mediastinal cancer, etc.) and breast cancer was associated with a higher risk of AF incidence compared with other solid cancer (HR: 1.64, 95% CI: 1.53–1.76, p<0.001). Conclusions Cancer was associated with an increased incidence of AF. Hematologic cancer was associated with higher risk of AF incidence than solid cancer. Among solid cancer, thoracic and breast cancer was most strongly associated with the risk of AF incidence. Funding Acknowledgement Type of funding source: None


2020 ◽  
Vol 46 (08) ◽  
pp. 895-907
Author(s):  
Nina D. Anfinogenova ◽  
Oksana Y. Vasiltseva ◽  
Alexander V. Vrublevsky ◽  
Irina N. Vorozhtsova ◽  
Sergey V. Popov ◽  
...  

AbstractPrompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.


2020 ◽  
Vol 21 (16) ◽  
pp. 5717 ◽  
Author(s):  
Estefanía Lozano-Velasco ◽  
Diego Franco ◽  
Amelia Aranega ◽  
Houria Daimi

Atrial fibrillation (AF) is known to be the most common supraventricular arrhythmia affecting up to 1% of the general population. Its prevalence exponentially increases with age and could reach up to 8% in the elderly population. The management of AF is a complex issue that is addressed by extensive ongoing basic and clinical research. AF centers around different types of disturbances, including ion channel dysfunction, Ca2+-handling abnormalities, and structural remodeling. Genome-wide association studies (GWAS) have uncovered over 100 genetic loci associated with AF. Most of these loci point to ion channels, distinct cardiac-enriched transcription factors, as well as to other regulatory genes. Recently, the discovery of post-transcriptional regulatory mechanisms, involving non-coding RNAs (especially microRNAs), DNA methylation, and histone modification, has allowed to decipher how a normal heart develops and which modifications are involved in reshaping the processes leading to arrhythmias. This review aims to provide a current state of the field regarding the identification and functional characterization of AF-related epigenetic regulatory networks


2007 ◽  
Vol 25 (14) ◽  
pp. 1882-1890 ◽  
Author(s):  
Diana Crivellari ◽  
Matti Aapro ◽  
Robert Leonard ◽  
Gunter von Minckwitz ◽  
Etienne Brain ◽  
...  

Screening and adjuvant postoperative therapies have increased survival among women with breast cancer. These tools are seldom applied in elderly patients, although the usually reported incidence of breast cancer is close to 50% in women 65 years or older, reaching 47% after 70 years in the updated Surveillance, Epidemiology, and End Results (SEER) database. Elderly breast cancer patients, even if in good medical health, were frequently excluded from adjuvant clinical trials. Women age 70 years who are fit actually have a median life expectancy of 15.5 years, ie, half of them will live much longer and will remain exposed for enough time to the potentially preventable risks of a relapse and specific death. In the last few years, a new concern about this issue has developed. Treatment now faces two major end points, as in younger women: to improve disease-free survival in the early stages, and to palliate symptoms in advanced disease. However, in both settings, the absolute benefit of treatment is critical because protecting quality of life and all its related aspects (especially functional status and independence), is crucial in older persons who have more limited life expectancy. Furthermore, the new hormonal compounds (aromatase inhibitors) and chemotherapeutic drugs (capecitabine, liposomal doxorubicin), are potentially less toxic than and equally as effective as older more established therapies. These new treatments bring new challenges including higher cost, and defining their benefit in elderly breast cancer must include an analysis of the cost/benefit ratio. These issues emphasize the urgent need to develop and support clinical trials for this older population of breast cancer patients both in the adjuvant and metastatic settings, a move that will take us from a prejudiced, age-based medicine to an evidence-based medicine.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhaojie Dong ◽  
Xin Du ◽  
Shangxin Lu ◽  
Chao Jiang ◽  
Shijun Xia ◽  
...  

Abstract Background Patients with atrial fibrillation (AF) underwent a high risk of hospitalization, which has not been paid much attention to in practice. Therefore, we aimed to assess the incidence, causes and predictors of hospitalization in AF patients. Methods From August 2011 to December 2017, a total number of 20,172 AF patients from the Chinese Atrial Fibrillation Registry (China-AF) Study were prospectively selected for this study. We described the incidence, causes of hospitalization by age groups and sex. The Fine-Gray competing risk model was employed to identify predictors of first all-cause and first cause-specific hospitalization. Results After a mean follow-up of 37.3 ± 20.4 months, 7,512 (37.2%) AF patients experienced one or more hospitalizations. The overall incidence of all-cause hospitalization was 24.0 per 100 patient-years. Patients aged < 65 years were predominantly hospitalized for AF (42.1% of the total hospitalizations); while patients aged 65–74 and ≥ 75 years were mainly hospitalized for non-cardiovascular diseases (43.6% and 49.3%, respectively). We found patients complicated with heart failure (HF)[hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.02–1.18], established coronary artery disease (CAD) (HR 1.24, 95%CI 1.17–1.33), ischemic stroke/transient ischemic attack (TIA) (HR 1.22, 95%CI 1.15–1.30), diabetes (HR 1.14, 95%CI 1.08–1.20), chronic obstructive pulmonary disease (COPD) (HR 1.28, 95%CI 1.02–1.62), gastrointestinal disorder (HR 1.37, 95%CI 1.21–1.55), and renal dysfunction (HR 1.24, 95%CI 1.09–1.42) had higher risks of hospitalization. Conclusions More than one-third of AF patients included in this study were hospitalized at least once during over 3-year follow-up. The main cause for hospitalization among the elderly patients (≥ 65 years) is non-cardiovascular diseases rather than AF. Multidisciplinary management of comorbidities should be advocated to reduce hospitalization in AF patients older than 65 years old. Clinical Registryhttp://www.chictr.org.cn/showproj.aspx?proj=5831. Unique identifier: ChiCTR-OCH-13003729. The registration date is October 22, 2013.


Stroke ◽  
1991 ◽  
Vol 22 (2) ◽  
pp. 209-214 ◽  
Author(s):  
P J Friedman

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