Burden of Cardiac Arrhythmias in Patients With Anthracycline-Related Cardiomyopathy

JACC Clin Electrophysiol. 2017 Feb;3(2):139-150. doi: 10.1016/j.jacep.2016.08.009. Epub 2016 Sep 28.

Authors

Matylda Mazur¹, Feilong Wang¹, David O Hodge², Brittany L Siontis³, Douglas S Beinborn¹, Hector R Villarraga¹, Amir Lerman¹, Paul A Friedman¹, Joerg Herrmann⁴

Affiliations

¹ Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
² Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida.
³ Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
⁴ Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: herrmann.joerg@mayo.edu.

PMID: 29759386
DOI: 10.1016/j.jacep.2016.08.009

Abstract

Objectives: The objective of this study was to determine the incidence of arrhythmias and device (internal cardiac defibrillator/cardiac resynchronization therapy defibrillator) therapies in patients with a diagnosis of cardiomyopathy and anthracycline exposure.

Background: The burden of arrhythmias in adult cancer survivors with anthracycline-related cardiomyopathy has not been studied, but might have important implications for clinical management and outcomes.

Methods: Retrospective cohort study of all patients with left ventricular dysfunction (LVD) who underwent internal cardiac defibrillator/cardiac resynchronization therapy defibrillator implantation at the Mayo Clinic from 1990 to 2012. Ninety-five patients were cancer survivors (on average, 5 years), 23 of which had anthracycline-related cardiomyopathy (CA-ACM) and 72 of which had non-anthracycline-related cardiomyopathy (CA-NACM). A second control group of 68 noncancer patients with ischemic heart disease-related LVD or dilated cardiomyopathy (ischemic heart disease [IHD]/DCM) was age- and gender-matched to patients with CA-ACM. All patients were followed for arrhythmias and appropriate ICD therapies, total mortality, heart transplantation, and left ventricular ejection fraction.

Results: More than 5.5 ± 3.0 years after device implantation, nonsustained ventricular tachycardia was the most common arrhythmia in patients with CA-ACM followed by atrial fibrillation and sustained ventricular tachycardia or fibrillation (73.9%, 56.6%, and 30.4%, respectively), which was not significantly different from CA-NACM and IHD/DCM. The 5-year rate of ICD therapies was 19.9% in the CA-ACM group versus 22.1% in the CA-NACM group and 32.6% in the IHD/DCM group (p = NS for both). Device therapy-free, heart transplantation-free, and/or overall survival as well as cardiac function dynamics over time were not different in patients with CA-ACM than in patients with CA-NACM and IHD/DCM.

Conclusions: This study indicates that the burden of arrhythmia in patients with anthracycline-related cardiomyopathy is not different from cancer and non-cancer patients with IHD-related LVD or DCM.

Keywords: arrhythmia; cardiomyopathy; cardiotoxicity; prognosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Anthracyclines / adverse effects*
Antineoplastic Agents / adverse effects*
Arrhythmias, Cardiac / chemically induced*
Arrhythmias, Cardiac / mortality
Arrhythmias, Cardiac / therapy
Cancer Survivors
Cardiac Resynchronization Therapy / mortality
Cardiac Resynchronization Therapy Devices*
Cardiomyopathies / chemically induced
Cardiomyopathies / mortality
Case-Control Studies
Cost of Illness*
Defibrillators, Implantable*
Female
Humans
Male
Middle Aged
Neoplasms / drug therapy
Retrospective Studies
United States / epidemiology
Ventricular Dysfunction, Left / chemically induced
Ventricular Dysfunction, Left / mortality
Ventricular Dysfunction, Left / therapy

Substances

Anthracyclines
Antineoplastic Agents