Atrial fibrillation (AF) is a prevalent abnormal heart rhythm that can lead to severe complications such as stroke, major bleeding, heart failure, and death. The chances of developing AF may be increased in patients with cancer and could reflect a worse prognosis. Because evidence-based treatment guidelines for patients with AF and cancer are currently not available, many questions surrounding the management of these patients remain.

In a review article published in Blood Reviews, Gordon Chu, MD, of the department of thrombosis and haemostasis at the Leiden University Medical Centre in the Netherlands, and colleagues summarized the current literature surrounding epidemiology, anticoagulation therapy, and risk assessment in patients with AF and cancer.

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Sarju Ganatra, MD, director of the cardio-oncology program at the Lahey Hospital and Medical Center in Burlington, Massachusetts, told Hematology Advisor, “Evidence increasingly shows that cancer and cardiovascular disease are interlinked through common risk factors, co-occurrence in an aging population, and the deleterious effects of cancer treatment on cardiovascular health. In turn, greater overlap between the 2 disease entities is expected.”

Dr Ganatra further explained that “[incidence of] AF, which is a common arrhythmia in general, is increased even further in patients with malignancies.”

Pathophysiology of AF and Cancer

The molecular mechanisms underlying the relationship between AF and cancer are still under investigation, but evidence surrounding these interactions has been increasing. Some studies suggest that cancer-associated inflammation may induce atrial remodelling, eventually leading to AF. Another model proposes that AF is caused by imbalances in autonomic nervous system function brought on by various emotional and physical stressors.

Other possible mechanisms include electrolyte disturbances, infections, and fluid imbalances. In rare cases, AF can be induced in a direct manner through metastasis into cardiac or surrounding tissues. Furthermore, some cancer treatment strategies have also been associated with the development of AF, including targeted therapies, anthracycline drugs, and alkylating agents.

“In rare instances, AF occurs due to direct tumor invasion of the heart, but more commonly, it is secondary to surgery, chronic inflammation, dysautonomia, metabolic abnormalities, and chemotherapy,” Dr Ganatra said.