Approximately, 2–16% of patients with cancer have atrial fibrillation (AF), and it is associated with a two-fold higher risk of systemic thromboembolism or stroke and a six-fold higher risk of developing heart failure.1 The use of anti-arrhythmic drugs (AADs) in patients with cancer is particularly challenging due to drug interactions with anti-neoplastic therapies leading to an increased propensity for QT prolongation and arrhythmias.1 Catheter ablation for AF is safe, and it is associated with superior clinical results as compared to medical therapy.2 However, there is limited data on the procedural safety and clinical outcomes of patients with cancer undergoing catheter ablation for AF. In this observational study, we examined the outcomes of patients with cancer undergoing catheter ablation in a nationally representative cohort of patients.
The National Readmissions Database (NRD) was analysed from 2016 to 2019 to identify patients ≥18 years old undergoing AF ablation as described previously.3,4 The NRD is the largest, publicly available, all-payer inpatient database in the USA that contains longitudinal, nationally representative information on hospital readmissions for all ages and contains data from approximately 18 million discharges annually.4 Due to the de-identified nature of the NRD dataset, the need for informed consent and Institutional Review Board approval was waived.
Patients were divided into three cohorts based on their cancer status: those with no cancer, those with active cancer [implantable cardioverter defibrillator (ICD) 10 CM codes: C00.x-C97.x], and those with prior history of cancer (ICD 10 CM codes: Z85.xx). The baseline characteristics were compared using a Pearson χ2 test and Fisher's exact test for categorical variables, and a one-way analysis of variance for continuous variables. A multivariable regression model (logistic for categorical outcomes and linear for continuous outcomes) was utilized to assess the independent association of active cancer and a history of cancer with in-hospital, 30-day, 90-day, and 180-day outcomes after adjusting for age, sex, and comorbidities as reported in Table 1. Definitions of outcomes of interest are reported in Table 1, defined using their respective ICD-10 CM codes. The statistical analysis was performed using STATA 17.0, and a P < 0.05 was considered statistically significant.
Table 1.
Baseline characteristics, outcomes, and procedure-related complications stratified by cancer status
| Variable no. (%) | No cancer (n = 43 232, 85.4%) | History of cancer (n = 5923, 11.7%) | Active cancer (n = 1468, 2.9%) | P-value |
|---|---|---|---|---|
| Females | 44.9% | 50.8% | 40.5% | <0.01 |
| Age (standard error) years | 68.8 (0.08) | 74.2 (0.17) | 74.3 (0.34) | <0.01 |
| CHA2DS2-VASc score | ||||
| ≤3 | 50.0% | 35.2% | 31.0% | <0.01 |
| 4 | 14.2% | 14.6% | 16.5% | |
| 5 | 13.9% | 18.9% | 20.6% | |
| ≥6 | 22.2% | 31.3% | 31.8% | |
| Type of cancer | ||||
| Oesophageal cancer | — | 0.7% | 1.7% | — |
| Colorectal cancer | — | 7.3% | 3.9% | — |
| Lung cancer | — | 6.3% | 14.3% | — |
| Breast cancer | — | 25.6% | 7.6% | — |
| Uterine cancer | — | 4.3% | 0.7% | — |
| Prostate cancer | — | 19.3% | 12.1% | — |
| Leukaemia | — | 0.9% | 18.8% | — |
| Lymphoma | — | 4.4% | 10.6% | — |
| Comorbidities | ||||
| Anaemia | 2.9% | 3.5% | 6.2% | <0.01 |
| Congestive heart failure | 52.4% | 54.5% | 65.3% | <0.01 |
| Valvular heart disease | 23.6% | 29.1% | 28.3% | <0.01 |
| Chronic obstructive pulmonary disease | 24.8% | 29.2% | 33.4% | <0.01 |
| Prior myocardial infarction | 8.7% | 9.5% | 8.8% | 0.43 |
| Prior stroke | 10.0% | 12.6% | 10.9% | <0.01 |
| Prior percutaneous coronary intervention | 1.1% | 1.3% | 1.4% | 0.62 |
| Prior coronary artery bypass graft | 7.3% | 8.6% | 8.4% | 0.06 |
| Diabetes | 28.0% | 25.3% | 31.3% | <0.01 |
| Hypertension | 78.4% | 82.0% | 81.9% | <0.01 |
| Liver disease | 2.9% | 3.1% | 5.7% | <0.01 |
| Renal failure | 22.0% | 25.8% | 28.9% | <0.01 |
| Peripheral vascular disorder | 13.6% | 15.2% | 16.7% | <0.01 |
| Coagulopathy | 5.8% | 6.1% | 12.3% | <0.01 |
| Obesity | 24.9% | 20.6% | 18.1% | <0.01 |
| Prior ICD | 6.9% | 6.7% | 7.3% | 0.86 |
| Prior permanent pacemaker | 10.4% | 14.6% | 15.9% | <0.01 |
| Long-term anticoagulation | 52.7% | 61.5% | 49.2% | <0.01 |
| Outcomes | ||||
| In-hospital mortality | 0.9% | 0.6% | 2.0% | <0.01 |
| Adjusted odds ratio (OR)a | Reference | 0.56 (0.33–1.05), P = 0.06 | 1.63 (0.93–2.83), P = 0.08 | |
| Any cardiovascular complicationb | 13.2% | 14.5% | 19.6% | <0.01 |
| Adjusted ORa | Reference | 0.95 (0.54–1.07), P = 0.41 | 1.21 (1.02–1.49), P = 0.04 | |
| Any peripheral vascular complicationc | 2.6% | 2.9% | 2.5% | 0.62 |
| Adjusted OR | Reference | 1.14 (0.89–1.45), P = 0.29 | 1.02 (0.65–1.61), P = 0.93 | |
| Any bleeding complicationd | 3.7% | 4.3% | 7.6% | <0.01 |
| Adjusted ORa | Reference | 1.09 (0.88–1.35), P = 0.43 | 1.73 (1.25–2.39), P < 0.01 | |
| Any pulmonary complicatione | 10.3% | 11.1% | 18.6% | <0.01 |
| Adjusted ORa | Reference | 0.96 (0.83–1.10), P = 0.55 | 1.55 (1.24–1.95), P < 0.01 | |
| Any neurological complicationf | 1.3% | 1.0% | 0.8% | 0.20 |
| Adjusted ORa | Reference | 0.69 (0.47–1.01), P = 0.06 | 0.44 (0.17–1.16), P = 0.09 | |
| Discharge to home | 75.5% | 70.6% | 54.6% | <0.01 |
| Adjusted ORa | Reference | 1.08 (0.98–1.20), P = 0.10 | 0.54 (0.45–0.65), P < 0.01 | |
| Length of stay | 4.8 (0.05) days | 4.9 (0.09) days | 8.2 (0.41) days | <0.01 |
| Adjusted mean difference (MD)a | Reference | − 0.38 (−0.68 - + 0.19) days, P = 0.11 | +2.35 (+1.55 - + 3.16) days, P < 0.01 | |
| 30-day all-cause readmissions | 10.3% | 11.1% | 15.0% | <0.01 |
| Adjusted ORa | Reference | 0.98 (0.86–113), P = 0.81 | 1.32 (1.07–1.62), P < 0.01 | |
| 30-day atrial fibrillation/flutter-related readmissions | 2.7% | 2.6% | 2.5% | 0.87 |
| Adjusted ORa | Reference | 1.01 (0.74–1.34), P = 0.99 | 1.02 (0.64–1.56), P = 0.98 | |
| 30-day heart failure-related admissions | 3.0% | 3.2% | 3.0% | 0.85 |
| Adjusted ORa | Reference | 0.88 (0.69–1.13), P = 0.33 | 0.78 (0.51–1.21), P = 0.27 | |
| 30-day stroke-related readmissions | 0.2% | 0.2% | 0.3% | 0.66 |
| Adjusted ORa | Reference | 0.76 (0.34–1.69), P = 0.50 | 1.42 (0.43–4.65), P = 0.56 | |
| 30-day bleeding-related readmissions | 0.6% | 0.9% | 1.5% | <0.01 |
| Adjusted ORa | Reference | 1.17 (0.74–1.86), P = 0.49 | 1.86 (1.08–3.20), P = 0.02 | |
| 90-day all-cause readmissions | 17.1% | 19.5% | 23.9% | <0.01 |
| Adjusted ORa | Reference | 1.02 (0.90–1.15), P = 0.76 | 1.28 (1.06–1.56), P = 0.01 | |
| 90-day atrial fibrillation/flutter-related readmissions | 4.3% | 4.5% | 4.4% | 0.87 |
| Adjusted ORa | Reference | 1.09 (0.86–1.39), P = 0.48 | 1.09 (0.73–1.63), P = 0.66 | |
| 90-day heart failure-related admissions | 4.7% | 5.3% | 5.3% | 0.38 |
| Adjusted ORa | Reference | 0.93 (0.75–1.15), P = 0.52 | 0.88 (0.61–1.28), P = 0.52 | |
| 90-day stroke-related readmissions | 0.4% | 0.5% | 0.7% | 0.31 |
| Adjusted ORa | Reference | 1.23 (0.68–2.24), P = 0.48 | 1.58 (0.63–3.96), P = 0.33 | |
| 90-day bleeding-related readmissions | 1.1% | 1.5% | 2.8% | <0.01 |
| Adjusted ORa | Reference | 1.20 (0.82–1.75), P = 0.34 | 2.14 (1.35–3.42), P < 0.01 | |
| 180-day all-cause readmissions | 22.8% | 25.7% | 31.6% | <0.01 |
| Adjusted ORa | Reference | 1.04 (0.91–1.18), P = 0.59 | 1.31 (1.05–1.64), P = 0.01 | |
| 180-day atrial fibrillation/flutter-related readmissions | 5.5% | 5.8% | 5.9% | 0.79 |
| Adjusted ORa | Reference | 1.14 (0.87–1.48), P = 0.34 | 1.19 (0.79–1.79), P = 0.39 | |
| 180-day heart failure-related admissions | 5.7% | 6.7% | 7.5% | 0.11 |
| Adjusted ORa | Reference | 0.97 (0.77–1.23), P = 0.81 | 1.06 (0.71–1.57), P = 0.77 | |
| 180-day stroke-related readmissions | 0.5% | 0.8% | 0.6% | 0.30 |
| Adjusted ORa | Reference | 1.33 (0.71–2.48), P = 0.38 | 1.23(0.31–3.34), P = 0.97 | |
| 180-day bleeding-related readmissions | 1.4% | 1.9% | 3.7% | <0.01 |
| Adjusted ORa | Reference | 1.14 (0.78–1.67), P = 0.50 | 2.08 (1.23–3.51), P < 0.01 | |
Adjusted for the following variables: age, gender, hypertension, diabetes mellitus, peripheral vascular disease, chronic lung disease, heart failure, chronic liver disease, prior stroke, history of percutaneous coronary intervention, history of coronary artery bypass graft, chronic renal failure, anaemia, CHA2DS2-VASc score, obesity, prior permanent pacemaker, prior implantable cardioverter defibrillator, and long-term anticoagulation.
Cardiovascular complications (including cardiac arrest, heart block, myocardial infarction, pericardial effusion, cardiogenic shock, and pericardial effusion requiring intervention).
Peripheral vascular complication (including arteriovenous fistula, pseudoaneurysm, and access site haematoma).
Bleeding complications (gastrointestinal bleeding, blood transfusion, and retroperitoneal bleeding).
Pulmonary complications (including respiratory failure, pneumothorax, pleural effusion, and pneumonia).
Neurological complications (including ischaemic stroke, haemorrhagic stroke, and transient ischaemic attack).
Our cohort included 50 623 weighted AF ablation procedures (Table 1), of which 5923 (11.7%) were performed in patients with a history of cancer and 1468 (2.9%) were performed in patients with active cancer. Patients with active cancer and a history of cancer were older at the time of ablation as compared to patients with no cancer [74.3 (0.34) vs. 74.2 (0.17) vs. 68.8 (0.08) years, P < 0.01] and had a higher burden of key comorbidities including heart failure (65.3% vs. 54.5% vs. 52.4%, P < 0.01), renal failure (28.9% vs. 25.8% vs. 22.0%, P < 0.01), and chronic pulmonary disease (33.4% vs. 29.2% vs. 24.8%, P < 0.01) (Table 1).
Crude outcomes are shown in Table 1. On multivariable analysis, the presence of active cancer was associated with significantly higher odds of cardiovascular complications [adjusted odds ratio (aOR) 1.21; 95% confidence interval (CI): 1.02–1.49; P = 0.04], bleeding complications (aOR:1.73; 95% CI: 1.25–2.39; P < 0.01), pulmonary complications (aOR:1.55; 95% CI: 1.25–1.95; P < 0.01), longer length of stay (adjusted mean difference: + 2.35; 95% CI: + 1.55 + 3.16; P < 0.01) days and lower odds of routine home discharge (aOR:0.54; 95% CI: 0.45–0.65; P < 0.01), as compared to those without cancer.
Patients with active cancer had significantly higher odds of 30-day all-cause readmissions (aOR:1.32; 95% CI: 1.07–1.62; P < 0.01), 30-day bleeding-related readmissions (aOR:1.86; 95% CI: 1.08–3.20; P = 0.02), 90-day all-cause readmissions (aOR:1.28; 95% CI: 1.06–1.56; P = 0.01), 90-day bleeding-related readmissions (aOR:2.14; 95% CI: 1.35–3.42; P < 0.01),180-day all-cause (aOR:1.31; 95% CI: 1.05–1.64; P = 0.01), and 180-day bleeding-related readmissions (aOR:2.08; 95% CI: 1.23–3.51; P < 0.01), without any difference in atrial fibrillation/flutter, stroke, and heart failure-related readmissions. Patients with a history of cancer had similar odds of periprocedural complications along with 30-day/90-day/180-day readmissions as compared to those with no cancer.
There is limited data on outcomes of AF ablation in patients with cancer, and our study provides important insights using a large national claims-based database. The significant findings include:
In patients undergoing catheter ablation for AF, 11.7% had a history of cancer, and 2.8% had active cancer.
Compared to patients without cancer, having a diagnosis of active cancer was associated with a higher adjusted odds of periprocedural complications and higher odds of 30-day/90-day/180-day all-cause readmissions and bleeding-related readmissions as compared to patients without cancer.
There was no significant difference in the odds of periprocedural complications and 30-day/90-day/180-day readmissions in patients with a history of cancer as compared to those without cancer.
Cancer and AF appear to have a bidirectional relationship, likely due to common risk factors.5 The incidence of AF has been found to be 3.0–4.5 times higher within the first year of a cancer diagnosis compared to later years.6 Conversely, an increased risk of cancer among patients presenting with AF has also been appreciated.6 The prognosis with AF has been shown to be worse among cancer patients compared to those without cancer, with a two-fold higher adjusted risk for thrombo-embolic complications, and a six-fold higher adjusted risk for heart failure.6 The underlying processes that explain the link between these two diseases remain unknown but might be biologically explained by the pro-inflammatory state, electrolyte, and fluid imbalance, and the possible presence of frailty.7,8 Atrial fibrillation has also previously been shown to be associated with poor outcomes in patients undergoing inpatient chemotherapy and among patients undergoing chimeric antigen receptor T cell therapy as well as patients undergoing haematopoietic stem cell transplants.9 A recent study by Thotamgari et al.10 including 750 patients with cancer from the national inpatient sample database demonstrated that patients with cancer undergoing AF ablation had higher odds of in-hospital mortality along with periprocedural major bleeding and pulmonary embolism (Table 2). Our study additionally compares outcomes of patients with a history of cancer to those without cancer and also analyses hospital readmission rates in patients with active cancer or a history of cancer to those without cancer. Another single-centre study by Ganatra et al.11 including 502 patients with cancer undergoing AF ablation showed that patients with cancer had similar odds of arrhythmia recurrence without any difference in the periprocedural complications compared to those without cancer (Table 2). Of note, the abovementioned study did not differentiate between the outcomes of patients with active cancer to those with a history of cancer, which might have contributed to the differences in the periprocedural outcomes as compared to our study.
Table 2.
Studies analysing the safety and efficacy of catheter ablation in patients with cancer
| Study (years) | Study design | Patients (n) | History of cancer/active cancer (n) | Age (mean) | Female (%) | Type of cancer (%) | Primary outcome | Results and conclusion | Follow-up(months) |
|---|---|---|---|---|---|---|---|---|---|
| Giustozzi et al.13 (2021) | Retrospective single centre | 184 | 21/- | 64.3 | 33.0 | Gastrointestinal (36%), breast (23%), and genitourinary (18%) | Clinically relevant bleeding, defined as the composite of major and clinically relevant non-major bleedings observed during 30 ± 5 days after the catheter ablation procedure. | Clinically relevant bleeding after catheter ablation for AF is more frequent in cancer survivors than in patients without cancer | 1 |
| Eitel et al.14 (2021) | Retrospective single centre | 140 | 62/8 | 71.3 | 44.3 | Genitourinary cancer (30%), breast cancer (28.6%), haemato-oncologic cancer (12.9%), gastrointestinal cancer (11.4%), head or neck cancer (5.7%), and lung cancer (2.9%) | Complications were defined as periprocedural when occurring intra-procedural, post-procedural during the hospital stay or until 30 days after the procedure. Complications were classified as major complications if permanent injury, interventional treatment, prolonged hospital stay, repeat hospitalization for more than 48 h, or death occurred, as described in the consensus statement for catheter ablation of AF. Bleeding complications were classified as described in the criteria of the International Society on Thrombosis and Haemostasis as major bleeding or clinically relevant non-major bleeding. | High arrhythmia-free survival with low frequencies of periprocedural complications was observed in patients with a history of cancer undergoing cryo-balloon ablation. Procedural safety and arrhythmia-free survival were comparable to patients without cancer disease. | 12 |
| Ganatra et al.11 (2023) | Retrospective single centre | 502 | 205/46 | 65.5 | 50.0 | Breast cancer (29.9%), lung cancer (6.0%), prostate cancer (22.3%), lymphoma (10.0%), and other cancer (31.9%) | Freedom from atrial fibrillation (with or without anti-arrhythmic drugs or need for repeat ablation) at 12 months post-ablation in patients with a history of cancer compared to controls. | The success rate, defined as freedom from recurrent AF, with or without AAD, and the need for repeat ablation at 12 months post-ablation, in patients with cancer was similar to that observed in non-cancer controls. At the same time, safety outcomes, including post-procedural bleeding, pulmonary vein stenosis, stroke, and cardiac tamponade within the first 3 months after catheter ablation, were also similar to non-cancer controls. | 12 |
| Thotamgari et al.10 (2023) | Retrospective multi-centre | 47 765 | 750/- | 67.1 | 42.0 | Haematological malignancy (60%), respiratory tract (16%), gastrointestinal (12%), breast (6%), and urinary tract (6%) | Mortality, major periprocedural cardiac complications including acute heart failure, acute myocardial infarction, cardiac arrest, cardiogenic shock, acute pericarditis, heart block, major bleeding, retroperitoneal bleeding, pulmonary embolism, and acute kidney injury. | Patients with cancer undergoing catheter ablation for atrial fibrillation had significantly higher odds of in-hospital mortality, major bleeding, and pulmonary embolism as compared to those without cancer. | In-hospital stay |
One of the major risks related to AF ablation is radiation exposure, in particular, the effects of ionizing radiation exposure which is both deterministic and stochastic.5 The latter is especially important in young patients with increased radiosensitivity and a longer life expectancy, as well as in patients who undergo a large cumulative radiation dose for long, difficult, or recurrent treatments.5 The radiation exposure, on the other hand, could result in a large cumulative dosage and a lifelong radiation risk for the electrophysiological staff.12 Therefore, it is important to reduce the amount of ionizing radiation that patients and personnel are exposed to. Although, in recent years, the development and widespread use of electro-anatomical mapping systems in conjunction with transoesophageal or intracardiac echocardiography during AF ablation has resulted in a significant reduction in ionizing radiation exposure but the lack of awareness of radiation exposure still persists.12 In this scenario, the awareness of radiation doses and risks, also during interventional cardiology procedures, is essential today to apply the risk-benefit assessment and to reinforce the principles of justification and optimization in clinical practice.12
Our findings are best interpreted in the context of their limitations. This includes the lack of patient-level data verification due to the use of a de-identified database, the retrospective observational cohort study design, the possibility of coding errors due to the use of ICD codes, the presence of unmeasured confounding, and the lack of longer-term follow-up. Also, we lacked data on the type, dose, and duration of chemotherapy and/or radiotherapy received by patients with active cancer or a history of cancer. Furthermore, we were unable to stratify outcomes based on the type of ablation strategy utilized (radiofrequency vs. cryo-energy). Therefore, our study findings should be considered hypothesis-generating at best.
In conclusion, our study identifies the association between active cancer and higher odds of periprocedural complications and all-cause and bleeding-related readmissions in patients undergoing AF ablation and suggests the need for multi-disciplinary decision-making and individually tailored therapeutic approaches given the benefits and risks of the procedure in this high-risk cohort of patients. Further prospective studies are required to confirm these findings and explore the outcomes of AF ablation in patients with cancer.
Contributor Information
Siddharth Agarwal, Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK 73104, USA.
Muhammad Bilal Munir, Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA.
Satyam Krishan, Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK 73104, USA.
Eric H Yang, UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
Ana Barac, Division of Cardio-Oncology, Inova Schar Cancer Institute and Inova Heart and Vascular Institute, Fairfax, VA, USA.
Zain Ul Abideen Asad, Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK 73104, USA.
Funding
This research did not receive any specific grant from public, commercial, or not-for-profit funding agencies.
Relationship with industry: None of the authors have industry relationships related to this manuscript.
Data availability
The authors confirm that the data supporting the findings of this study are available upon reasonable request from the authors.
References
- 1. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi Met al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J 2016;37:2768–801. [DOI] [PubMed] [Google Scholar]
- 2. Asad ZUA, Yousif A, Khan MS, Al-Khatib SM, Stavrakis S. Catheter ablation versus medical therapy for atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials. Circ Arrhythm Electrophysiol 2019;12:e007414. [DOI] [PubMed] [Google Scholar]
- 3. Arora S, Jaswaney R, Jani C, Zuzek Z, Thakkar S, Patel HPet al. Catheter ablation for atrial fibrillation in patients with concurrent heart failure. Am J Cardiol 2020;137:45–54. [DOI] [PubMed] [Google Scholar]
- 4.“Healthcare Cost and Utilization Project. Overview of the Nationwide Readmissions Database (NRD)”. https://www.hcup-us.ahrq.gov/nrdoverview.jsp. (23 January 2023, date last accessed).
- 5. Garibaldi S, Chianca M, Fabiani I, Emdin M, Piacenti M, Passino Cet al. Treatment options in AF patients with cancer; focus on catheter ablation. J Clin Med 2022;11:4452. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Guha A, Dey AK, Jneid H, Ibarz JP, Addison D, Fradley M. Atrial fibrillation in the era of emerging cancer therapies. Eur Heart J 2019;40:3007–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Guha A, Fradley MG, Dent SF, Weintraub NL, Lustberg MB, Alonso Aet al. Incidence, risk factors, and mortality of atrial fibrillation in breast cancer: a SEER-Medicare analysis. Eur Heart J 2022;43:300–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Savelieva I, Fumagalli S, Kenny RA, Anker S, Benetos A, Boriani Get al. EHRA expert consensus document on the management of arrhythmias in frailty syndrome, endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA). Europace 2023;25:1249–76. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Krishan S, Munir MB, Khan MZ, Al-Juhaishi T, Nipp R, DeSimone CVet al. Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation. Europace 2023;25:euad129. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Thotamgari SR, Sheth AR, Patel HP, Sandhyavenu H, Patel B, Grewal USet al. Safety of catheter ablation for atrial fibrillation in patients with cancer: a nationwide cohort study. Postgrad Med 2023;135:562–8. [DOI] [PubMed] [Google Scholar]
- 11. Ganatra S, Abraham S, Kumar A, Parikh R, Patel R, Khadke Set al. Efficacy and safety of catheter ablation for atrial fibrillation in patients with history of cancer. Cardiooncology 2023;9:19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Giaccardi M, Anselmino M, Del Greco M, Mascia G, Paoletti Perini A, Mascia Pet al. Radiation awareness in an Italian multispecialist sample assessed with a web-based survey. Acta Cardiol 2021;76:307–11. [DOI] [PubMed] [Google Scholar]
- 13. Giustozzi M, Ali H, Reboldi G, Balla C, Foresti S, de Ambroggi Get al. Safety of catheter ablation of atrial fibrillation in cancer survivors. J Interv Card Electrophysiol 2021;60:419–26. [DOI] [PubMed] [Google Scholar]
- 14. Eitel C, Sciacca V, Bartels N, Saraei R, Fink T, Keelani Aet al. Safety and efficacy of cryoballoon based pulmonary vein isolation in patients with atrial fibrillation and a history of cancer. J Clin Med 2021;10:3669. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The authors confirm that the data supporting the findings of this study are available upon reasonable request from the authors.