A Primer on the Evolving Subspecialty of Onco-Electrophysiology

Cardio-oncology has become a well-established subspecialty because of the growing burden of cardiovascular diseases in oncology patients, resulting from the cardiac toxicities of cancer therapies and the coexistence of both conditions in the same population. As with other cardiovascular conditions, cardiac arrhythmias have emerged as an important concern in patients with cancer. However, the management of arrhythmias is more complicated in these patients because of complex interactions between oncotherapeutics and arrhythmia-treatment strategies. Similarly, patients with cardiac implantable electronic devices (CIEDs) require cancer treatment strategies that involve radiation therapy require specific management strategies. Thus, there is a need for a specific mechanistic understanding of electrophysiological abnormalities, arrhythmia, and device management in oncology patients, especially given the expanding range of oncologic therapies and radiation strategies. This increasingly prevalent clinical challenge requires new expertise that expands on a yearly basis. This narrative review deals with this recent expansion and addresses key areas of onco-electrophysiology, including the mechanistic basis of common electrocardiographic changes, diagnosis, and management of arrhythmias attributable to oncotherapeutics and the care of patients with arrhythmias who require oncologic therapies, especially patients with devices and drug interactions leading to arrhythmias as seen by cardiac physicians dealing with oncology patients. In addition, it reviews evolving management strategies and protocols for patients with implantable devices, especially if urgent radiation is needed. This review aims to bridge the recent knowledge growth in arrhythmia care for patients with cancer and highlight the evolution of onco-electrophysiology as a subspeciality.