Cardiotoxicity and cardiac arrhythmias in cancer therapy: a review of current evidence

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Abstract

Cardiac arrhythmias are among the most frequent and clinically significant manifestations of anticancer therapy-induced cardiotoxicity. Despite substantial progress in oncology and the increasing availability of targeted and immunological treatments, the incidence of cardiovascular complications, including rhythm disturbances, continues to rise.

This article provides a comprehensive review of current evidence on the association between various types of anticancer therapies — including traditional cytotoxic chemotherapy, targeted therapies, immune checkpoint inhibitors, Chimeric antigen receptor T-cell therapy, and Bispecific T-cell engager therapy — and the development of arrhythmias. Special attention is given to pathophysiological mechanisms, including direct cardiomyocyte toxicity, electrophysiological disturbances due to ion channel blockade, ischemic myocardial injury, and inflammatory changes. The review outlines the clinical manifestations of common arrhythmias such as atrial fibrillation, ventricular tachycardia and atrioventricular block caused by different classes of anticancer drugs. Additionally, it discusses modern approaches to the diagnosis, screening, and prevention of arrhythmic complications in patients with cancer. A key emphasis is placed on the importance of a multidisciplinary approach involving close collaboration among cardiologists, oncologists, and clinical pharmacists to optimize treatment safety and efficacy while preventing potentially life-threatening conditions. Finally, the article highlights the need for further research into molecular mechanisms and the development of standardized monitoring algorithms in patients undergoing anticancer therapy, including the application of digital health technologies and artificial intelligence.

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About the authors

Valeria A. Kolomyitseva

Rostov State Medical University

Author for correspondence.
Email: aonext@mail.ru
ORCID iD: 0009-0009-5768-0661
Russian Federation, Nakhichevan Lane, building 29, Rostov-on-Don, 344022

Liana A. Zaripova

Samara State Medical University

Email: Venera.zaripova.74@mail.ru
ORCID iD: 0009-0001-7749-8762
Russian Federation, Samara

Darina A. Bazhina

N.N. Burdenko Voronezh State Medical University

Email: bazhinadarina@yandex.ru
ORCID iD: 0009-0007-1278-7903
Russian Federation, Voronezh

Aiganat P. Aidemirova

Rostov State Medical University

Email: aika.aidemirova22@mail.ru
ORCID iD: 0009-0002-3628-2305
Russian Federation, Rostov-on-Don

Murat S. Gumerov

Bashkir State Medical University

Email: bashspider@gmail.com
ORCID iD: 0009-0007-3719-2260
Russian Federation, Ufa

Maryam A. Uyanaeva

Rostov State Medical University

Email: maramuanava@gmail.com
ORCID iD: 0009-0003-6036-1828
Russian Federation, Rostov-on-Don

Pavel N. Furs

Bashkir State Medical University

Email: pasha.furs.2000@mail.ru
ORCID iD: 0009-0008-2438-0649
Russian Federation, Ufa

Venera M. Gadeeva

Bashkir State Medical University

Email: gadeevavenera@mail.ru
ORCID iD: 0009-0008-8555-7057
Russian Federation, Ufa

Timur A. Salyakhov

Bashkir State Medical University

Email: timasalyakhov@icloud.com
ORCID iD: 0009-0003-0027-7181
Russian Federation, Ufa

Liana R. Gazislamova

Bashkir State Medical University

Email: Gazislamova@bk.ru
ORCID iD: 0009-0008-6715-9338
Russian Federation, Ufa

Artem V. Vasilyev

Bashkir State Medical University

Email: artem19a19@gmail.com
ORCID iD: 0009-0007-7082-0556
Russian Federation, Ufa

Diana A. Koksheneva

Kuban State Medical University

Email: kokhseneva123rus16@gmail.com
ORCID iD: 0009-0007-3154-3752
Russian Federation, Krasnodar

Тагир R. Osmanov

Rostov State Medical University

Email: nata.mitrofanova.78@mail.ru
ORCID iD: 0009-0007-6852-669X
Russian Federation, Rostov-on-Don

Victoria V. Fedorenko

Rostov State Medical University

Email: fedorovalika128@gmail.com
ORCID iD: 0009-0006-0181-1827
Russian Federation, Rostov-on-Don

Askar R. Gareev

Bashkir State Medical University

Email: askar.gareev@inbox.ru
ORCID iD: 0009-0008-8862-4884
Russian Federation, Ufa

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