Arrhythmias associated with immune checkpoint inhibitor therapy-A clinical perspective

Immune checkpoint inhibitors (ICIs) have transformed cancer therapy but are associated with a growing spectrum of cardiovascular immune-related adverse events. Among these, arrhythmias represent a rare yet potentially life-threatening complication. ICI-induced arrhythmias encompass a wide clinical spectrum, including atrial arrhythmias, conduction disturbances and malignant ventricular arrhythmias. This review summarizes the current evidence on the incidence, clinical presentation, pathophysiological mechanisms and management of ICI-associated arrhythmias. We discuss the limitations of available data, which are largely derived from case reports, small series and retrospective registries, and highlight the implications for clinical practice. Improved understanding of ICI-induced arrhythmias is essential to balance oncological efficacy with cardiovascular safety in this, rapidly expanding, patient population.