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Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis
Background Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients wi...
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| Published in: | Journal of interventional cardiac electrophysiology 2024-01, Vol.67 (1), p.211-219 |
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| container_title | Journal of interventional cardiac electrophysiology |
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| creator | Costa, Thomaz Alexandre Felix, Nicole Clemente, Mariana Teixeira, Larissa Braga, Marcelo Antonio Pinheiro Silva, Livia Teixeira Martins |
| description | Background
Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients with versus without prior or active cancer.
Methods
We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of CA for AF in cancer survivors. Outcomes of interest were bleeding events, late AF recurrence, and need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints.
Results
We included 5 retrospective cohort studies comprising 998 patients, of whom 41.4% had a history of cancer. Cancer survivors were at significantly higher risk of clinically relevant bleeding (OR 2.17; 95% CI 1.17-4.0; p=0.01) as compared with those without cancer. The efficacy of CA for AF was similar between groups. Late AF recurrence at 12 months was not significantly different between patients with vs. without a history of cancer (OR 1.29; 95% CI 0.78–2.13; p=0.32). Similar findings were observed in the outcome of repeat ablations (OR 0.71; 95% CI 0.37-1.37; p=0.31).
Conclusions
These findings suggest that cancer survivors have an increased risk of bleeding after CA for AF relative to patients without cancer, with no significant difference in the efficacy of CA for maintenance of sinus rhythm between groups.
Study registration
This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023394538.
Graphical abstract |
| doi_str_mv | 10.1007/s10840-023-01677-8 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2889244134</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2889244134</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-7c33286391d4525eebb3773b45a0c091f1f2bd9f0c0b936fc1d3cc2660794e603</originalsourceid><addsrcrecordid>eNp9kUtvFiEUhonR2Iv-AReGxI2b0cNtGNyZxlaTJl2oa8IwB6WZSwXmayb--dJ-n5e4cAUHnvMeyEPICwZvGIB-mxl0EhrgogHWat10j8gxU5o3nTLq8V_7I3KS8zUAGODtU3IktFHApDomPz-7gGWjbh4ohhC98xtdAvWufMeCibp-dCUuMw1LLUqKbqQh9imOh_M4V3j2Fc1r2sXdkvI76mjecsGpIp4m3EW8fRgxYXGNm9245ZifkSfBjRmfH9ZT8vX8w5ezj83l1cWns_eXjRdalUZ7IXjXCsMGqbhC7HuhteilcuDBsMAC7wcTatEb0QbPBuE9b1vQRmIL4pS83ufepOXHirnYKWaP9QMzLmu2vOsMl5IJWdFX_6DXy5rqeytlGGhmpFaV4nvKpyXnhMHepDi5tFkG9l6N3auxVY19UGO72vTyEL32Ew6_W365qIDYA7lezd8w_Zn9n9g7TqWaQQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2910719475</pqid></control><display><type>article</type><title>Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis</title><source>Springer Link</source><creator>Costa, Thomaz Alexandre ; Felix, Nicole ; Clemente, Mariana ; Teixeira, Larissa ; Braga, Marcelo Antonio Pinheiro ; Silva, Livia Teixeira Martins</creator><creatorcontrib>Costa, Thomaz Alexandre ; Felix, Nicole ; Clemente, Mariana ; Teixeira, Larissa ; Braga, Marcelo Antonio Pinheiro ; Silva, Livia Teixeira Martins</creatorcontrib><description>Background
Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients with versus without prior or active cancer.
Methods
We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of CA for AF in cancer survivors. Outcomes of interest were bleeding events, late AF recurrence, and need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints.
Results
We included 5 retrospective cohort studies comprising 998 patients, of whom 41.4% had a history of cancer. Cancer survivors were at significantly higher risk of clinically relevant bleeding (OR 2.17; 95% CI 1.17-4.0; p=0.01) as compared with those without cancer. The efficacy of CA for AF was similar between groups. Late AF recurrence at 12 months was not significantly different between patients with vs. without a history of cancer (OR 1.29; 95% CI 0.78–2.13; p=0.32). Similar findings were observed in the outcome of repeat ablations (OR 0.71; 95% CI 0.37-1.37; p=0.31).
Conclusions
These findings suggest that cancer survivors have an increased risk of bleeding after CA for AF relative to patients without cancer, with no significant difference in the efficacy of CA for maintenance of sinus rhythm between groups.
Study registration
This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023394538.
Graphical abstract</description><identifier>ISSN: 1572-8595</identifier><identifier>ISSN: 1383-875X</identifier><identifier>EISSN: 1572-8595</identifier><identifier>DOI: 10.1007/s10840-023-01677-8</identifier><identifier>PMID: 37950145</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Ablation ; Atrial Fibrillation ; Bleeding ; Cancer ; Cancer Survivors ; Cardiac arrhythmia ; Cardiology ; Catheter Ablation - adverse effects ; Catheters ; Confidence intervals ; Effectiveness ; Fibrillation ; Hemorrhage - epidemiology ; Humans ; Medical instruments ; Medicine ; Medicine & Public Health ; Meta-analysis ; Neoplasms - surgery ; Radiofrequency ablation ; Recurrence ; Retrospective Studies ; Reviews ; Risk ; Safety ; Statistical analysis ; Survival ; Systematic review ; Treatment Outcome</subject><ispartof>Journal of interventional cardiac electrophysiology, 2024-01, Vol.67 (1), p.211-219</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-7c33286391d4525eebb3773b45a0c091f1f2bd9f0c0b936fc1d3cc2660794e603</citedby><cites>FETCH-LOGICAL-c375t-7c33286391d4525eebb3773b45a0c091f1f2bd9f0c0b936fc1d3cc2660794e603</cites><orcidid>0009-0007-7819-2400 ; 0000-0003-1789-6694 ; 0009-0000-7714-7148 ; 0000-0002-8282-442X ; 0009-0005-5842-9007 ; 0000-0001-8174-3866</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27898,27899</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37950145$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Costa, Thomaz Alexandre</creatorcontrib><creatorcontrib>Felix, Nicole</creatorcontrib><creatorcontrib>Clemente, Mariana</creatorcontrib><creatorcontrib>Teixeira, Larissa</creatorcontrib><creatorcontrib>Braga, Marcelo Antonio Pinheiro</creatorcontrib><creatorcontrib>Silva, Livia Teixeira Martins</creatorcontrib><title>Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis</title><title>Journal of interventional cardiac electrophysiology</title><addtitle>J Interv Card Electrophysiol</addtitle><addtitle>J Interv Card Electrophysiol</addtitle><description>Background
Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients with versus without prior or active cancer.
Methods
We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of CA for AF in cancer survivors. Outcomes of interest were bleeding events, late AF recurrence, and need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints.
Results
We included 5 retrospective cohort studies comprising 998 patients, of whom 41.4% had a history of cancer. Cancer survivors were at significantly higher risk of clinically relevant bleeding (OR 2.17; 95% CI 1.17-4.0; p=0.01) as compared with those without cancer. The efficacy of CA for AF was similar between groups. Late AF recurrence at 12 months was not significantly different between patients with vs. without a history of cancer (OR 1.29; 95% CI 0.78–2.13; p=0.32). Similar findings were observed in the outcome of repeat ablations (OR 0.71; 95% CI 0.37-1.37; p=0.31).
Conclusions
These findings suggest that cancer survivors have an increased risk of bleeding after CA for AF relative to patients without cancer, with no significant difference in the efficacy of CA for maintenance of sinus rhythm between groups.
Study registration
This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023394538.
Graphical abstract</description><subject>Ablation</subject><subject>Atrial Fibrillation</subject><subject>Bleeding</subject><subject>Cancer</subject><subject>Cancer Survivors</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Catheter Ablation - adverse effects</subject><subject>Catheters</subject><subject>Confidence intervals</subject><subject>Effectiveness</subject><subject>Fibrillation</subject><subject>Hemorrhage - epidemiology</subject><subject>Humans</subject><subject>Medical instruments</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Neoplasms - surgery</subject><subject>Radiofrequency ablation</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Reviews</subject><subject>Risk</subject><subject>Safety</subject><subject>Statistical analysis</subject><subject>Survival</subject><subject>Systematic review</subject><subject>Treatment Outcome</subject><issn>1572-8595</issn><issn>1383-875X</issn><issn>1572-8595</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kUtvFiEUhonR2Iv-AReGxI2b0cNtGNyZxlaTJl2oa8IwB6WZSwXmayb--dJ-n5e4cAUHnvMeyEPICwZvGIB-mxl0EhrgogHWat10j8gxU5o3nTLq8V_7I3KS8zUAGODtU3IktFHApDomPz-7gGWjbh4ohhC98xtdAvWufMeCibp-dCUuMw1LLUqKbqQh9imOh_M4V3j2Fc1r2sXdkvI76mjecsGpIp4m3EW8fRgxYXGNm9245ZifkSfBjRmfH9ZT8vX8w5ezj83l1cWns_eXjRdalUZ7IXjXCsMGqbhC7HuhteilcuDBsMAC7wcTatEb0QbPBuE9b1vQRmIL4pS83ufepOXHirnYKWaP9QMzLmu2vOsMl5IJWdFX_6DXy5rqeytlGGhmpFaV4nvKpyXnhMHepDi5tFkG9l6N3auxVY19UGO72vTyEL32Ew6_W365qIDYA7lezd8w_Zn9n9g7TqWaQQ</recordid><startdate>20240101</startdate><enddate>20240101</enddate><creator>Costa, Thomaz Alexandre</creator><creator>Felix, Nicole</creator><creator>Clemente, Mariana</creator><creator>Teixeira, Larissa</creator><creator>Braga, Marcelo Antonio Pinheiro</creator><creator>Silva, Livia Teixeira Martins</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0009-0007-7819-2400</orcidid><orcidid>https://orcid.org/0000-0003-1789-6694</orcidid><orcidid>https://orcid.org/0009-0000-7714-7148</orcidid><orcidid>https://orcid.org/0000-0002-8282-442X</orcidid><orcidid>https://orcid.org/0009-0005-5842-9007</orcidid><orcidid>https://orcid.org/0000-0001-8174-3866</orcidid></search><sort><creationdate>20240101</creationdate><title>Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis</title><author>Costa, Thomaz Alexandre ; Felix, Nicole ; Clemente, Mariana ; Teixeira, Larissa ; Braga, Marcelo Antonio Pinheiro ; Silva, Livia Teixeira Martins</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-7c33286391d4525eebb3773b45a0c091f1f2bd9f0c0b936fc1d3cc2660794e603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Ablation</topic><topic>Atrial Fibrillation</topic><topic>Bleeding</topic><topic>Cancer</topic><topic>Cancer Survivors</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Catheter Ablation - adverse effects</topic><topic>Catheters</topic><topic>Confidence intervals</topic><topic>Effectiveness</topic><topic>Fibrillation</topic><topic>Hemorrhage - epidemiology</topic><topic>Humans</topic><topic>Medical instruments</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Neoplasms - surgery</topic><topic>Radiofrequency ablation</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Reviews</topic><topic>Risk</topic><topic>Safety</topic><topic>Statistical analysis</topic><topic>Survival</topic><topic>Systematic review</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Costa, Thomaz Alexandre</creatorcontrib><creatorcontrib>Felix, Nicole</creatorcontrib><creatorcontrib>Clemente, Mariana</creatorcontrib><creatorcontrib>Teixeira, Larissa</creatorcontrib><creatorcontrib>Braga, Marcelo Antonio Pinheiro</creatorcontrib><creatorcontrib>Silva, Livia Teixeira Martins</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of interventional cardiac electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Costa, Thomaz Alexandre</au><au>Felix, Nicole</au><au>Clemente, Mariana</au><au>Teixeira, Larissa</au><au>Braga, Marcelo Antonio Pinheiro</au><au>Silva, Livia Teixeira Martins</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis</atitle><jtitle>Journal of interventional cardiac electrophysiology</jtitle><stitle>J Interv Card Electrophysiol</stitle><addtitle>J Interv Card Electrophysiol</addtitle><date>2024-01-01</date><risdate>2024</risdate><volume>67</volume><issue>1</issue><spage>211</spage><epage>219</epage><pages>211-219</pages><issn>1572-8595</issn><issn>1383-875X</issn><eissn>1572-8595</eissn><abstract>Background
Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients with versus without prior or active cancer.
Methods
We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of CA for AF in cancer survivors. Outcomes of interest were bleeding events, late AF recurrence, and need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints.
Results
We included 5 retrospective cohort studies comprising 998 patients, of whom 41.4% had a history of cancer. Cancer survivors were at significantly higher risk of clinically relevant bleeding (OR 2.17; 95% CI 1.17-4.0; p=0.01) as compared with those without cancer. The efficacy of CA for AF was similar between groups. Late AF recurrence at 12 months was not significantly different between patients with vs. without a history of cancer (OR 1.29; 95% CI 0.78–2.13; p=0.32). Similar findings were observed in the outcome of repeat ablations (OR 0.71; 95% CI 0.37-1.37; p=0.31).
Conclusions
These findings suggest that cancer survivors have an increased risk of bleeding after CA for AF relative to patients without cancer, with no significant difference in the efficacy of CA for maintenance of sinus rhythm between groups.
Study registration
This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023394538.
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| subjects | Ablation Atrial Fibrillation Bleeding Cancer Cancer Survivors Cardiac arrhythmia Cardiology Catheter Ablation - adverse effects Catheters Confidence intervals Effectiveness Fibrillation Hemorrhage - epidemiology Humans Medical instruments Medicine Medicine & Public Health Meta-analysis Neoplasms - surgery Radiofrequency ablation Recurrence Retrospective Studies Reviews Risk Safety Statistical analysis Survival Systematic review Treatment Outcome |
| title | Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis |
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