Burden of Cardiac Arrhythmias in Patients With Anthracycline-Related Cardiomyopathy

• Published in: JACC. Clinical electrophysiology 2017-02, Vol.3 (2), p.139-150
• Main Authors: Mazur, Matylda, MD, Wang, Feilong, MD, Hodge, David O., MS, Siontis, Brittany L., MD, Beinborn, Douglas S, Villarraga, Hector R., MD, Lerman, Amir, MD, Friedman, Paul A., MD, Herrmann, Joerg, MD
• Format: Article
• Language: English
• Subjects: arrhythmia; cardiomyopathy; cardiotoxicity; Cardiovascular; prognosis
• ISSN: 2405-500X; 2405-5018
• 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.