Cath Ablation for AF No Less Safe, Effective in Cancer Patients

Why This Matters

  • Catheter ablation for AF is underused in patients with cancer because of a perceived risk for downstream complications associated with exposure to potentially cardiotoxic and proarrhythmic agents.

  • This study argues against such concerns, demonstrating that catheter ablation is an effective and safe approach to treating AF in patients with cancer.


Study Design

  • The retrospective cohort study compared the efficacy and safety of catheter ablation for AF in adult patients with or without cancer.

  • The patients with cancer had a history of cancer within the past 5 years or exposure to anthracyclines or thoracic radiation at any time before the ablation. Patients with nonmelanoma skin cancer were excluded.

  • The primary endpoint was freedom from AF and repeat catheter ablation at 12 months.

  • Safety endpoints included bleeding requiring intervention, pulmonary vein stenosis, stroke, and cardiac tamponade within 3 months of the ablation procedure.


Key Results

  • Of the study's 502 patients undergoing catheter ablation for AF, 251 (50%) had a history of cancer. They and the 50% without cancer had similar prevalence of hypertension, diabetes, tobacco use, obstructive sleep apnea, coronary artery disease, valvular heart disease, congestive heart failure, and history of cerebrovascular events.

  • The most common cancer diagnosis was breast cancer, in 20% of cases; about 15% of the cancer patients received anthracyclines.

  • More than half of patients in both groups had paroxysmal AF, 54.2% of cancer patients and 56.2% of controls.

  • Cardioversion had been attempted prior to ablation in 60.2% of patients with cancer and 57.8% of controls.

  • Radiofrequency ablation was used in 58.2% of patients with cancer and 8.4% of controls (< .001). Cryoablation was used in 36.2% and 53.4%, respectively (< .001), and both ablation modalities were used in 5.6% and 38.3%, respectively (P < .001).

  • Most 12-month outcomes were similar for cancer patients and patients without cancer, including freedom from AF, 83.3% and 72.5%, respectively (= .28); and repeat ablation, 20.7% and 27.5%, respectively (= .29).

  • Of the patients with cancer, 50.6% were free of AF without antiarrhythmic drugs at 12 months compared with 35% of controls (P < .001).

  • There were no significant differences in rate of repeat ablation or 3-month safety endpoints.


    • Selection bias among patients referred for ablation can't be ruled out in this retrospective cohort study.

    • Relatively few patients in the cancer group had active cancer, so the observed efficacy of ablation in that group may not accurately reflect results in clinical practice.


    • This study received no funding, grants, or support.

    • One author was supported by the Catherine Fitch Fund and the Gelb Master Clinician Fund at Brigham and Women's Hospital.

    • Another author disclosed consulting for Intrinsic Imaging, Bristol Myers Squibb, AbbVie, Genentech, Roche, Sanofi, C-4 Therapeutics, CRO Oncology, and Amgen and receiving grant funding from AstraZeneca and Bristol Myers Squibb.