Predictors of Atrial Fibrillation After Thoracic Radiotherapy

Overview

Journal JACC CardioOncol

Date 2025 Jan 13

PMID 39801654

Authors

Santino Butler

Hyunsoo No

Felicia Guo

Gibran Merchant

Natalie J Park

Scott Jackson

Daniel Eugene Clark

Lucas Vitzthum

Alex Chin

Kathleen Horst

Richard T Hoppe

Billy W Loo

Maximilian Diehn

Michael Sargent Binkley

Affiliations

Soon will be listed here.

Abstract

Background: Atrial fibrillation (AF) has been associated with thoracic radiotherapy, but the specific risk with irradiating different cardiac substructures remains unknown.

Objectives: This study sought to examine the relationship between irradiation of cardiac substructures and the risk of clinically significant (grade ≥3) AF.

Methods: We analyzed data from patients who underwent definitive radiotherapy for localized cancers (non-small cell lung, breast, Hodgkin lymphoma, or esophageal) at our institution between 2004 and 2022. The 2-Gy fraction equivalent dose was calculated for cardiac substructures, including the pulmonary veins (PVs), left atrium, sinoatrial node, and left coronary arteries (the left main, left anterior descending, and left circumflex arteries). Competing risk models (subdistribution HRs [sHRs]) for AF incidence were adjusted for the Mayo AF risk score (MAFRS).

Results: Among 539 patients, the median follow-up was 58.8 months. The 5-year cumulative incidence of AF was 11.1% for non-small cell lung cancer, 8.3% for esophageal cancer, 1.3% for breast cancer, and 0.8% for Hodgkin lymphoma. Increased AF risk was associated with a higher PV maximum dose (d) (sHR: 1.22; 0.001), larger left atrial volume (sHR: 1.01; 0.002), greater smoking history in pack-years (sHR: 1.01; 0.010), and higher MAFRS (sHR: 1.16; 0.001). PV d remained a significant predictor of AF across different MAFRS subgroups ( = 0.11), and a PV d >39.7 Gy was linked to a higher AF risk, even when stratified by MAFRS.

Conclusions: PV d is a significant predictor of grade ≥3 AF regardless of underlying risk factors. These findings highlight the importance of cardiac substructures in radiation toxicity and suggest that various PV dose metrics should be further validated in clinical settings.

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