07 Jun Ventricular Arrhythmias Are Common in Patients With Advanced Cancers and ICDs
MedicalResearch.com Interview with:
Dr. Andres Enriquez
Andrés Enriquez, MD
Heart Rhythm Service
Queen’s University and Kingston General Hospital
Kingston, Ontario, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Enriquez: An increasingly frequent scenario for professionals who work with cardiac implantable devices is being called from the Oncology or Radiotherapy services to assess patients who have received shocks from their implantable cardioverter-defibrillators (ICDs). Interestingly, most of these patients had received their devices for primary prevention and have no prior history of ventricular arrhythmias.
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Enriquez: In the present study, the authors analyzed a retrospective cohort of 1598 patients with ICDs followed at the Device Clinics of Kingston, Ontario. Of these, 102 patients (6.2%) received a pathological diagnosis of cancer. After the diagnosis of malignancy, 32% of patients experienced ventricular arrhythmias (VT/VF) over a follow-up period of ~2 years. The frequency of arrhythmic events increased by a factor of 10 after the diagnosis of cancer (1.19 ± 0.32 versus 0.12 ± 0.21 episodes per month, respectively; p 0.03) and was markedly higher in patients with stage IV cancer than in those with earlier stages (p 0.03). In this group, the incidence of VT/VF was 41.2%, with an average of 7.2 ± 18.5 events per patient, all of whom received ICD shocks.
MedicalResearch.com: What should readers take away from your report?
Dr. Enriquez: The main conclusion of this study is that ventricular arrhythmias are frequent in patients with cancer and ICDs and the incidence is higher in those with advanced metastatic disease.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Enriquez: The association between cardiac disease and cancer is not casual. Both conditions are prevalent (first and second cause of death in developed countries, respectively) and share common risk factors, including tobacco abuse and an unhealthy diet. However, the pathophysiological mechanisms underlying the increased incidence of ventricular arrhythmias in cancer are not clear and deserve further investigation. Possible factors include systemic proinflammatory state, tumoral involvement of the heart, electrolytic imbalances and cardiotoxic effects of antineoplastic drugs or radiation therapy.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Enriquez: A side message of this study is that ICD deactivation was only performed in one third of patients with stage IV cancer. ICD shocks are painful, provoke anxiety and may prolong the process of dying. On the other side, sudden arrhythmic death is the kind of death most people hope for: painless, quick and peaceful. ICD handling is an important aspect of care in patients nearing end of life and physicians should discuss with patients and families the option of ICD deactivation. In accordance with a 2010 consensus statement issued by the Heart Rhythm Society, ICD deactivation is neither physician-assisted suicide nor euthanasia and is ethically acceptable if concordant with patient’s goals of care.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Enriquez A, Biagi J, Redfearn D, et al. Increased Incidence of Ventricular Arrhythmias in Patients With Advanced Cancer and Implantable Cardioverter-Defibrillators.JACCCEP. 2016;():. doi:10.1016/j.jacep.2016.03.001.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
More Medical Research Interviews on MedicalResearch.com
[wysija_form id=”5″]
Last Updated on June 7, 2016 by Marie Benz MD FAAD