PDF(Pubmed)
Abstract：
BACKGROUND: There have been controversial findings from recent studies regarding anthracyclines use and the subsequent risk of arrhythmias. This study aimed to evaluate the existing evidence of the risk of arrhythmias in patients treated with anthracyclines.
METHODS: PubMed, Scopus, and Web of Science databases were searched up to April 2022 using keywords such as \"anthracycline\" and \"arrhythmia.\" Dichotomous data were presented as relative risk (RR) and confidence interval (CI), while continuous data were presented as mean difference (MD) and CI. Revman software version 5.4 was used for the analysis.
RESULTS: Thirteen studies were included with a total of 26891 subjects. Pooled analysis showed that anthracyclines therapy was significantly associated with a higher risk of arrhythmia (RR: 1.58; 95% CI: 1.41-1.76; P < .00001), ST segment and T wave abnormalities (RR: 1.73, 95% CI: 1.18-2.55, P = .005), conduction abnormalities and AV block (RR = 1.86, 95% CI = 1.06-3.25, P = .03), and tachycardia (RR: 1.736, 95% CI: 1.11-2.69, P = .02). Further analyses of the associations between anthracyclines and atrial flutter (RR = 1.30, 95% CI = 0.29-5.89, P = .74), atrial ectopic beats (RR: 1.27, 95% CI: 0.78-2.05, P = .34), and ventricular ectopic beats (RR: 0.93, 95% CI: 0.53-1.65, P = .81) showed no statistically significant results. Higher doses of anthracycline were associated with a higher risk of arrhythmias (RR: 1.49; 95% CI: 1.08-2.05; P = .02) compared to the lower doses (RR: 1.36; 95% CI: 1.00-1.85; P = .05). Newer generations of Anthracycline maintained the arrhythmogenic properties of previous generations, such as Doxorubicin.
CONCLUSIONS: Anthracyclines therapy was significantly associated with an increased risk of arrhythmias. Accordingly, Patients treated with anthracyclines should be screened for ECG abnormalities and these drugs should be avoided in patients susceptible to arrhythmia. The potential benefit of the administration of prophylactic anti-fibrotic and anti-arrhythmic drugs should also be explored.
METHODS: PubMed, Scopus, and Web of Science databases were searched up to April 2022 using keywords such as \"anthracycline\" and \"arrhythmia.\" Dichotomous data were presented as relative risk (RR) and confidence interval (CI), while continuous data were presented as mean difference (MD) and CI. Revman software version 5.4 was used for the analysis.
RESULTS: Thirteen studies were included with a total of 26891 subjects. Pooled analysis showed that anthracyclines therapy was significantly associated with a higher risk of arrhythmia (RR: 1.58; 95% CI: 1.41-1.76; P < .00001), ST segment and T wave abnormalities (RR: 1.73, 95% CI: 1.18-2.55, P = .005), conduction abnormalities and AV block (RR = 1.86, 95% CI = 1.06-3.25, P = .03), and tachycardia (RR: 1.736, 95% CI: 1.11-2.69, P = .02). Further analyses of the associations between anthracyclines and atrial flutter (RR = 1.30, 95% CI = 0.29-5.89, P = .74), atrial ectopic beats (RR: 1.27, 95% CI: 0.78-2.05, P = .34), and ventricular ectopic beats (RR: 0.93, 95% CI: 0.53-1.65, P = .81) showed no statistically significant results. Higher doses of anthracycline were associated with a higher risk of arrhythmias (RR: 1.49; 95% CI: 1.08-2.05; P = .02) compared to the lower doses (RR: 1.36; 95% CI: 1.00-1.85; P = .05). Newer generations of Anthracycline maintained the arrhythmogenic properties of previous generations, such as Doxorubicin.
CONCLUSIONS: Anthracyclines therapy was significantly associated with an increased risk of arrhythmias. Accordingly, Patients treated with anthracyclines should be screened for ECG abnormalities and these drugs should be avoided in patients susceptible to arrhythmia. The potential benefit of the administration of prophylactic anti-fibrotic and anti-arrhythmic drugs should also be explored.
摘要：
背景：最近关于蒽环类药物的使用和随后的心律失常风险的研究有争议的发现。本研究旨在评估蒽环类药物治疗患者心律失常风险的现有证据。
方法：PubMed，Scopus,到2022年4月，使用“蒽环类药物”和“心律失常”等关键词搜索了WebofScience数据库。“二分类数据以相对风险(RR)和置信区间(CI)表示，而连续数据以平均差(MD)和CI表示。Revman软件版本5.4用于分析。
结果：共纳入了13项研究，共26891名受试者。汇总分析显示，蒽环类药物治疗与更高的心律失常风险显着相关（RR：1.58;95％CI：1.41-1.76;P<.00001），ST段和T波异常（RR：1.73，95％CI：1.18-2.55，P=0.005），传导异常和房室传导阻滞（RR=1.86，95%CI=1.06-3.25，P=0.03），和心动过速（RR：1.736，95%CI：1.11-2.69，P=.02）。进一步分析蒽环类药物与房扑的相关性(RR=1.30,95%CI=0.29-5.89,P=.74),心房异位搏动（RR：1.27，95%CI：0.78-2.05，P=0.34），和心室异位搏动（RR：0.93，95％CI：0.53-1.65，P=0.81）显示无统计学意义的结果。与低剂量（RR：1.36；95％CI：1.00-1.85；P=0.05）相比，较高剂量的蒽环类抗生素与较高的心律失常风险相关（RR：1.49；95％CI：1.08-2.05；P=.02）。新一代的蒽环类药物保持了前几代人的致心律失常特性，如阿霉素。
结论：蒽环类药物治疗与心律失常风险增加显著相关。因此，使用蒽环类药物治疗的患者应筛查心电图异常，易患心律失常的患者应避免使用这些药物。还应探讨预防性抗纤维化和抗心律失常药物的潜在益处。
方法：PubMed，Scopus,到2022年4月，使用“蒽环类药物”和“心律失常”等关键词搜索了WebofScience数据库。“二分类数据以相对风险(RR)和置信区间(CI)表示，而连续数据以平均差(MD)和CI表示。Revman软件版本5.4用于分析。
结果：共纳入了13项研究，共26891名受试者。汇总分析显示，蒽环类药物治疗与更高的心律失常风险显着相关（RR：1.58;95％CI：1.41-1.76;P<.00001），ST段和T波异常（RR：1.73，95％CI：1.18-2.55，P=0.005），传导异常和房室传导阻滞（RR=1.86，95%CI=1.06-3.25，P=0.03），和心动过速（RR：1.736，95%CI：1.11-2.69，P=.02）。进一步分析蒽环类药物与房扑的相关性(RR=1.30,95%CI=0.29-5.89,P=.74),心房异位搏动（RR：1.27，95%CI：0.78-2.05，P=0.34），和心室异位搏动（RR：0.93，95％CI：0.53-1.65，P=0.81）显示无统计学意义的结果。与低剂量（RR：1.36；95％CI：1.00-1.85；P=0.05）相比，较高剂量的蒽环类抗生素与较高的心律失常风险相关（RR：1.49；95％CI：1.08-2.05；P=.02）。新一代的蒽环类药物保持了前几代人的致心律失常特性，如阿霉素。
结论：蒽环类药物治疗与心律失常风险增加显著相关。因此，使用蒽环类药物治疗的患者应筛查心电图异常，易患心律失常的患者应避免使用这些药物。还应探讨预防性抗纤维化和抗心律失常药物的潜在益处。
