Incidence of new-onset atrial fibrillation after thoracic radiotherapy in non-small cell lung cancer: a systematic review and meta-analysis.
Asayel M Alsultan, Reman A AlAbdulaaly, Saud A Alyahya et al.
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In 30 seconds
This systematic review and meta-analysis examined new-onset atrial fibrillation (AF) after thoracic radiotherapy in patients with non-small cell lung cancer, using observational studies. Nine retrospective cohorts were reviewed, and eight contributed to quantitative synthesis; six studies with 4410 patients and 736 events informed the primary analysis. The pooled proportion of new-onset AF was 0.14 (95%CI 0.07-0.24), with substantial heterogeneity (I2 = 94.0%). Across studies, AF risk appeared associated with radiation exposure to cardiac substructures, including the sinoatrial node, pulmonary veins, and atrial structures.
Key findings
- Six studies including 4410 patients and 736 events contributed to the primary analysis.
- The pooled proportion of new-onset AF was 0.14 (95%CI 0.07-0.24), with substantial heterogeneity (I2 = 94.0%).
- In three studies, pooled cumulative incidence was 0.09 (95% CI, 0.00-0.84; I2 = 0.0%), but the estimate was highly imprecise.
- AF risk appeared associated with radiation exposure to the sinoatrial node, pulmonary veins, and atrial structures.
Why it matters
AF may be a clinically relevant component of cardiac toxicity after thoracic radiotherapy for NSCLC. The pooled estimate provides an indication of its potential frequency, while the marked variation between studies and imprecision in cumulative-incidence estimates mean the evidence does not establish a reliable individual risk. Attention to cardiac substructure exposure and consistent outcome reporting may help clarify this risk.
What to keep in mind
Evidence came from retrospective cohorts and was markedly heterogeneous; the cumulative-incidence estimate was highly imprecise. The authors call for prospective validation and standardized outcome reporting.