Key result
Anthracycline therapy was significantly associated with a higher risk of arrhythmia (RR 1.58; 95% CI 1.41-1.76; P < .00001).
Why the study?
Recent studies have yielded controversial findings regarding anthracycline use and the subsequent risk of arrhythmias.
Does anthracycline therapy increase the risk of arrhythmias in treated patients?
Meta-Analysis (n=26,891)
Does anthracycline therapy increase the risk of arrhythmias in treated patients?
Relative Risk: 1.58 (95% CI 1.41–1.76)
p-value: p=< .00001
Anthracycline therapy is significantly associated with an increased risk of arrhythmias, highlighting the need for ECG screening in treated patients.
Anthracycline use was associated with higher arrhythmia risk; supports ECG monitoring in treated patients but leaves causal confirmation to prospective trials.
BACKGROUND: There have been controversial findings from recent studies regarding anthracyclines use and the subsequent risk of arrhythmias. This study aimed to evaluate the existing evidence of the risk of arrhythmias in patients treated with anthracyclines. METHODS: PubMed, Scopus, and Web of Science databases were searched up to April 2022 using keywords such as "anthracycline" and "arrhythmia." Dichotomous data were presented as relative risk (RR) and confidence interval (CI), while continuous data were presented as mean difference (MD) and CI. Revman software version 5.4 was used for the analysis. RESULTS: Thirteen studies were included with a total of 26891 subjects. Pooled analysis showed that anthracyclines therapy was significantly associated with a higher risk of arrhythmia (RR: 1.58; 95% CI: 1.41-1.76; P < .00001), ST segment and T wave abnormalities (RR: 1.73, 95% CI: 1.18-2.55, P = .005), conduction abnormalities and AV block (RR = 1.86, 95% CI = 1.06-3.25, P = .03), and tachycardia (RR: 1.736, 95% CI: 1.11-2.69, P = .02). Further analyses of the associations between anthracyclines and atrial flutter (RR = 1.30, 95% CI = 0.29-5.89, P = .74), atrial ectopic beats (RR: 1.27, 95% CI: 0.78-2.05, P = .34), and ventricular ectopic beats (RR: 0.93, 95% CI: 0.53-1.65, P = .81) showed no statistically significant results. Higher doses of anthracycline were associated with a higher risk of arrhythmias (RR: 1.49; 95% CI: 1.08-2.05; P = .02) compared to the lower doses (RR: 1.36; 95% CI: 1.00-1.85; P = .05). Newer generations of Anthracycline maintained the arrhythmogenic properties of previous generations, such as Doxorubicin. CONCLUSION: Anthracyclines therapy was significantly associated with an increased risk of arrhythmias. Accordingly, Patients treated with anthracyclines should be screened for ECG abnormalities and these drugs should be avoided in patients susceptible to arrhythmia. The potential benefit of the administration of prophylactic anti-fibrotic and anti-arrhythmic drugs should also be explored.
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Dean et al. (2023) conducted a meta-analysis in Patients treated with anthracyclines (n=26,891). Anthracyclines was evaluated on Arrhythmia (RR 1.58, 95% CI 1.41-1.76, p=< .00001). Anthracycline therapy was significantly associated with a higher risk of arrhythmia (RR 1.58; 95% CI 1.41-1.76; P < .00001).
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