Author + information
- Anam Waheed, MD∗ (, )
- Samir Saba, MD and
- Jae Lee, MD
- ↵∗Department of Internal Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213
We are writing in reference to the paper by Enriquez et al. (1) published in JACC: Clinical Electrophysiology in the January 2017 issue. With increasing prevalence and mortality due to both cancer and cardiovascular diseases, the interface between these 2 fields is an upcoming area of discourse.
This present study highlights the increased burden of life-threatening arrhythmia and implantable cardioverter-defibrillator (ICD) shocks experienced by patients with malignant cancers. Published American College of Cardiology guidelines for ICD placement recommend against device insertion in patients with expected survival of <1 year. Nevertheless, approximately 50% of cancer patients in this study had their ICD placed after their cancer was diagnosed, making the reader wonder how many of these patients had advanced stages of cancer and limited expected longevity. It would have been extremely interesting to know more about mortality outcomes in this cohort as well as about the time from device implantation to death. It would have also been extremely informative to get more details regarding the patients’ functional status and prognosis when the ICD was implanted. Unfortunately, the present study does not provide these details. Given ICD placement after diagnosis of malignancy, a shared decision making process incorporating the patients’ prognosis, values, and personal beliefs seems imperative.
The current study fails to stratify patients’ risk for arrhythmia and shocks by type of cancer (i.e., skin cancer vs. hematologic malignancy vs. gastrointestinal vs. lung malignancy). Each cancer has a different pathophysiologic effect that may lead to more ventricular arrythmogenicity through different mechanisms. The degree of arrhythmogenicity could be related to the type of cancer in question but also to the combination of chemotherapeutic agents used in its treatment. The lack of granularity in the data presented in this study is unfortunate. Still, the authors should be commended for shedding an initially bright light on device therapy in oncology patients. As is often the case in medicine, initial lights uncover many underexplored dimensions. Cardiovascular care of oncology patients need to be the focus of future in-depth studies.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation