Cardiac Arrhythmias Associated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

Immune checkpoint inhibitors (ICIs) are increasingly associated with cardiovascular immune-related adverse events, including arrhythmias, though their incidence remains incompletely defined. PubMed/MEDLINE and Google Scholar were systematically searched from inception to February 2026 for studies reporting arrhythmia outcomes in patients receiving ICIs. A random-effects meta-analysis of proportions was performed. Twenty-two studies were included, of which 13 studies comprising 31,542 patients were included in the quantitative synthesis. The pooled incidence of arrhythmias was 6.89% [95% confidence interval (CI): 4.4-9.4%; I2 = 99.07%]. Subgroup analyses demonstrated an incidence of atrial fibrillation of 6.8% (95% CI: 0.0-15.3%; I2 = 95.3%) and conduction disorders of 1.44% (95% CI: 0.0-3.07%; I2 = 88.5%). ICIs are associated with a measurable burden of arrhythmias, particularly atrial fibrillation. However, substantial heterogeneity limits precision, highlighting the need for prospective studies with standardized monitoring strategies.