Bradyarrhythmias Associated with Oncologic Treatment-An Updated Review

Area of Science:

• Cardiology
• Oncology
• Pharmacology

Background:

• Bradyarrhythmias are an under-recognized cardiovascular toxicity of cancer therapies.
• Increasing use of targeted and immune therapies presents challenges in managing sinus node dysfunction and AV conduction disease.
• These cardiac issues can disrupt effective cancer treatment.

Purpose of the Study:

• To synthesize evidence on the incidence, phenotype, mechanisms, and management of bradyarrhythmias associated with major anticancer drug classes.
• To provide clinicians with a comprehensive overview of bradyarrhythmic risks in cancer patients.
• To inform clinical practice regarding monitoring and management strategies.

Main Methods:

• A narrative review of PubMed and clinical guidelines was conducted.
• Prioritization of prospective trials and large observational cohorts for incidence data.
• Inclusion of case reports, regulatory information, and pharmacovigilance data for phenotype and management details.

Main Results:

• Bradyarrhythmias range from sinus bradycardia to high-grade AV block requiring pacing.
• Immune checkpoint inhibitors are associated with the most severe phenotypes (myocarditis).
• Specific agents like ALK inhibitors, 5-fluorouracil, and taxanes show reproducible sinus bradycardia signals; other drug classes also show associations with varying evidence strength.

Conclusions:

• Bradyarrhythmias during cancer therapy are diverse and clinically significant.
• Class-specific patterns of bradyarrhythmia should be recognized.
• Proactive monitoring (ECG, electrolytes) and tailored management (drug adjustment, pacing, risk control) are crucial to minimize treatment interruption and maintain oncologic efficacy.