Prevalence of atrial fibrillation in cancer patients treated with radiation therapy: a systematic review and meta-analysis

Q: What are the key findings of this study?

Radiation therapy in cancer patients was associated with a pooled atrial fibrillation prevalence of 8.5% (95% CI 5.6%–12.0%) across 23 studies.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cancer treated with radiation therapy (n=97213). Intervention: Radiation therapy. Primary outcome: Pooled prevalence of atrial fibrillation (95% CI 5.6%-12.0%, p=<0.001).

Q: What does this research mean for the field?

The pooled prevalence of atrial fibrillation among cancer patients receiving radiation therapy is 8.5%, with substantial variation across cancer types and significant association with baseline coronary artery disease prevalence. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To describe the stratified prevalence of atrial fibrillation in patients with cancer undergoing radiation therapy and evaluate factors contributing to between-study variability.

Adil Sarvar Mohammed; NG Patel; Sandeep Guntuku; Shanmukh Sai Pavan Lingamsetty; Rishabh Baskara Salian; Ravi Venkata Sai Krishna Medarametla; Maya Asami Takagi; Uzma Yasmeen; Rupak Desai; Omar Javed Baqal; Hema Narayanasamy

doi:10.1186/s40959-026-00597-6

October 29, 2026Cardio-OncologyOpen Access

Prevalence of atrial fibrillation in cancer patients treated with radiation therapy: a systematic review and meta-analysis

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Key result

Radiation therapy in cancer patients is linked to an ~8% pooled prevalence of AF.

95% CI 5.6%-12.0%
P<0.001
n=97,213

Why the study?

Radiation therapy is associated with cardiovascular complications including AF, but the prevalence of AF in patients with cancer receiving radiation therapy and the sources of variability across studies remained poorly characterized.

Key Points

To describe the stratified prevalence of atrial fibrillation in patients with cancer undergoing radiation therapy and evaluate factors contributing to between-study variability.
Systematic search across PubMed, Scopus, Cochrane Library, and Google Scholar from inception to April 2026 (registered on PROSPERO CRD420261382387).
Analyzed 23 studies comprising 28 independent cohorts and 97,213 cancer patients receiving radiation therapy.
Calculated pooled prevalence estimates using a random-effects model, with subgroup analyses by cancer type and region, and multivariable meta-regression across 16 cohorts.
The overall pooled prevalence of atrial fibrillation was 8.5% (95% CI, 5.6% to 12.0%) with substantial heterogeneity (I² = 99.1%).
Prevalence varied by malignancy, reaching 15.0% (95% CI, 9.0% to 22.2%) in esophageal cancer, 7.4% (95% CI, 5.1% to 10.0%) in lung cancer, and 3.7% (95% CI, 0.6% to 9.2%) in breast cancer.
In multivariable meta-regression, baseline coronary artery disease was significantly associated with higher atrial fibrillation prevalence (β = 0.0490 per 10-percentage-point increase; p = 0.0185), whereas chemotherapy exposure was not (p = 0.36).

Study Design

Type

Meta-Analysis (n=97,213)

Multicenter

Yes

Structured PICO

P

Population

97,213 adult cancer patients across 23 studies treated with radiation therapy, excluding studies reporting atrial fibrillation solely as a perioperative or postoperative surgical complication.

E

Exposure

Radiation therapy (RT), irrespective of radiation technique or modality

O

Outcome

Pooled prevalence of atrial fibrillation (AF) occurring among patients with cancer treated with radiation therapyhard clinical

Main Result

p-value: p=<0.001

This systematic review and meta-analysis demonstrates that atrial fibrillation affects 8.5% of cancer patients treated with radiation therapy—and up to 15.0% of those with esophageal cancer—with pre-existing coronary artery disease serving as a significant study-level correlate of AF prevalence.

Limitations

High between-study heterogeneity (I2 = 99.1%) limits the interpretability of the pooled prevalence estimate.
Inclusion of multiple cancer types with differing biological characteristics and treatment approaches introduces clinical heterogeneity.
Meta-regression used study-level data, which is subject to ecological bias and does not reflect individual-level associations.
Inconsistent reporting of chemotherapy regimens, radiation dose, treatment timing, and cardiac substructure exposure.
Multivariable meta-regression included only 16 cohorts with five moderator coefficients, limiting statistical power.
Observational nature of most included studies precludes causal inference and allows for residual confounding.
Variability in atrial fibrillation ascertainment methods across studies may introduce measurement bias.
Literature search excluded EMBASE and Web of Science, creating a potential selection bias.
High between-study heterogeneity (I² = 99.1%) and substantial residual heterogeneity after multivariable meta-regression (I² = 91.49%)
Incomplete covariate reporting and a limited number of cohorts (16 cohorts) included in the adjusted meta-regression model
Associations were derived from study-level data and cannot be interpreted as independent patient-level risk factors or causal relationships
Independent contributions of co-occurring exposures (such as chemotherapy and surgical resection) could not be disentangled from radiation therapy
Variability in AF ascertainment methods (electrocardiographic monitoring, clinical diagnosis, registry-based reporting) and inconsistent reporting of radiation techniques and cardiac substructure dosimetry across included studies

Implication

Signals need for AF monitoring in radiation-treated cancer patients; extends cardio-oncology evidence by quantifying prevalence and CAD correlation.

Abstract

Background Radiation therapy (RT) is associated with cardiovascular complications, such as atrial fibrillation (AF). The prevalence of AF in patients with cancer receiving RT remains poorly characterized. This study describes the stratified prevalence of AF in patients with cancer receiving RT and explores the sources of variability across studies. Methods A comprehensive literature search was performed using PubMed, Scopus, Cochrane Library, and Google Scholar from the inception to April 2026 to identify studies reporting AF prevalence among patients receiving RT. Pooled prevalence estimates with 95% CI were calculated using a random-effects model. Between-study heterogeneity was assessed using the I2 statistic and Cochran’s Q test. Subgroup analyses were performed by cancer type, region, and study design. Meta-regression evaluated associations between AF prevalence and chemotherapy exposure, age, baseline coronary artery disease (CAD) prevalence, and cancer type. Leave-one-out sensitivity analysis was conducted. This study was prospectively registered on PROSPERO (CRD420261382387). Results Twenty-three studies, including 97,213 patients, were analyzed. The pooled prevalence of AF was 8.5% (95% CI 5.6–12.0%), with severe heterogeneity (I2 = 99.1%). Reported prevalence varied across studies, with higher estimates in esophageal cancer (15.0%), followed by lung (7.4%) and breast cancer (3.7%). In multivariable meta-regression (16 cohorts), higher baseline CAD prevalence was significantly associated with AF prevalence (β = 0.0490 per 10-percentage-point increase; p = 0.0185), whereas chemotherapy exposure and individual cancer-type comparisons were not significant. The model explained 54.2% of between-study heterogeneity, although substantial residual heterogeneity persisted (I² = 91.49%). Sensitivity analysis showed stable estimates (7.8–9.1%). Conclusion This meta-analysis revealed that the pooled prevalence of AF in patients with cancer receiving RT was 8.5%. Further prospective studies are required to clarify the nature and determinants of this observation. Clinical trial Not Applicable.

Discussion

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Cite This Study

Mohammed et al. (2026) conducted a meta-analysis in Cancer treated with radiation therapy (n=97,213). Radiation therapy was evaluated on Pooled prevalence of atrial fibrillation (95% CI 5.6%-12.0%, p=<0.001). Radiation therapy in cancer patients was associated with a pooled atrial fibrillation prevalence of 8.5% (95% CI 5.6%–12.0%) across 23 studies.

synapsesocial.com/papers/6ae4c6f2f5f953b5b4fb6482 https://doi.org/10.1186/s40959-026-00597-6

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Prevalence of atrial fibrillation in cancer patients treated with radiation therapy: a systematic review and meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Prevalence of atrial fibrillation in cancer patients treated with radiation therapy: a systematic review and meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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