Cancer treatment and atrial fibrillation: use of pharmacovigilance databases to detect cardiotoxicity

This editorial refers to ‘Identification of anticancer drugs associated with atrial fibrillation: analysis of the WHO pharmacovigilance database’, by J. Alexandre et al.

Atrial fibrillation (AF) is the most common sustained arrhythmia in the general population with a prevalence of 1.5–2%. Patients with malignancies are at increased risk of developing AF, as cancer and AF share several common risk factors, such as ageing and cardiometabolic disease, while cancer therapy, including surgery and systemic anticancer agents, and cancer itself may predispose to AF (Figure 1).

The relationship between cancer and AF seems to be bidirectional. Healthy patients with new-onset AF seem to have an increased longterm risk of developing cancer, while patients with newly diagnosed cancer seem to be at an increased risk of developing AF, with the highest incidence during the first 90 days from cancer diagnosis.