Ventricular arrhythmic burden and cardiac remodelling in patients with heart failure with reduced ejection fraction due to anthracycline cardiotoxicity: preliminary data of a multicenter study

Background Anthracycline-induced cardiomyopathy (AICM) is a severe manifestation of cardiotoxicity associated with adverse cardiac remodeling and symptomatic heart failure. The arrhythmic risk in AICM remains an underinvestigated area with critical implications for patients' management and outcomes. Methods This multicenter, retrospective study analyzed 60 patients with heart failure with reduced ejection fraction (HFrEF) secondary to AICM. Data were collected at baseline, at dysfunction diagnosis, and during the last available follow-up. Primary outcomes included major arrhythmic events and sudden cardiac death. Data on all-cause mortality, HF hospitalizations and episodes of ventricular arrhythmias recorded by devices or ECG-Holter monitoring were collected. Cardiac remodeling and HF symptoms during the observation period were also analyzed. Results At dysfunction diagnosis, severe cardiac impairment was present (median LVEF: 30%). During follow-up, significant positive remodeling was observed, with improvements in LVEF and reductions in LVEDV (p<0.001 for both). A trend toward improvement in NYHA class was also noted, with variability in therapeutic response. While the use of guideline-directed medical therapy improved during follow-up, only 33% of patients adhered to the four pillars heart failure therapy. Ventricular fibrillation occurred in 2 patients, both of whom survived after the event and received ICD. Non-sustained ventricular tachycardia was recorded in 10% of patients. ICD/CRT-D devices were implanted in 39% of the cohort. Conclusions This study highlights significant cardiac remodeling and symptomatic improvements in AICM patients receiving optimized HF therapy. However, the arrhythmic burden underscores the need for integrated strategies to address arrhythmia prevention in this high-risk population.