Anthracycline therapy for breast cancer-induced arrhythmias: a meta-analysis of a single-arm trial

Abstract

Abstract Introduction: As of 2020, breast cancer has become the leading cause of cancer incidence worldwide, and chemotherapy based on anthracycline is an important component of breast cancer treatment. Anthracycline-based drugs are known to cause cardiac toxicity and arrhythmia in breast cancer treatment. This is the first clinical quantitative analysis to accurately assess the incidences of arrhythmia and arrythmia subtypes and abnormal electrocardiogram (ECG) changes, providing data to support clinical drug use and drug monitoring. Methods: We systematically searched CNKI, VIP, Wanfang and other Chinese databases, PubMed, Embase, Web of Science, Cochrane Library and other English databases.The random effect model or fixed effect model was used to calculate the incidence of combined arrhythmias in breast cancer patients and the associated heterogeneity. STATA16 was used for statistical analysis. Results: A total of 37 articles were included in this study, including 5705 breast cancer patients treated with anthracyclines, of whom 2257 developed arrhythmias. Meta-analysis showed that the incidence of anthracycline-associated arrhythmias in breast cancer patients was 0.41 (0.37, 0.44). Subgroup analysis showed that the incidence of QT-QTc interphase change was 0.08 (0.05, 0.11), that of P wave change was 0.10 (0.05, 0.15), that of ST-T segment change was 0.19 (0.15, 0.23), and that of QT-QTc interphase change was 0.08 (0.05, 0.11). The incidence of low voltage abnormalities was 0.05 (0.03, 0.08). In addition, according to the subgroup analysis of arrhythmia subtypes, the incidence of conduction block was 0.04 (0.02, 0.05), the incidence of heart rate changes was 0.12 (0.10, 0.15), the incidence of premature beats was 0.09 (0.07, 0.11), and the incidence of atrial fibrillation was 0.04 (0.00, 0.12). Conclusion: The overall incidence of anthracycline-associated arrhythmias in breast cancer treatment was 0.41. ST-T segment was the most common ECG change. The results of this study are of great significance for guiding postoperative chemotherapy for and monitoring of breast cancer patients. Trial registration: The study has been registered in the international prospective register of systematic reviews(PROSPERO). Registration No.: CRD42022321213.