[Arrhythmias and electrocardiographic characteristics in cancer patients treated with immune checkpoint inhibitors]

Zhonghua Xin Xue Guan Bing Za Zhi. 2024 Jun 24;52(6):690-697. doi: 10.3760/cma.j.cn112148-20231008-00264.
[Article in Chinese]


Objective: To evaluate the incidence of arrhythmias and electrocardiographic (ECG) characteristics in cancer patients treated with immune checkpoint inhibitors (ICIs). Methods: This was a cohort study conducted in the Fourth Hospital of Hebei Medical University. Cancer patients initiating ICIs treatments from November 2020 to September 2022 were included in this study. Baseline 12-leads ECG before ICIs initiation and post-treatment ECG were analyzed. An abnormal ECG was defined as the presence of any of the following changes: sinus arrhythmias, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, ventricular tachycardia, premature contractions, conduction disorder, and ST-T changes. Results: A total of 87 patients were enrolled, aged 63 (57, 68) years, with 66 (75.9%) males. And 44.8% (39/87) of patients presented with at least one confirmed cardiovascular disease or cardiovascular risk factor at baseline. The incidence of abnormal ECG increased from 31.0% (27/87) at baseline to 65.5% (57/87) after receiving (5.0±2.7) cycles of ICIs treatment (P<0.001). The incidence of sinus arrhythmias was significantly increased after ICIs treatment (23.0% (20/87) vs. 9.2% (8/87), P=0.023), of which only the incidence of sinus tachycardia was significantly increased (11.5% (10/87) vs. 2.3% (2/87), P=0.039). There was also a significantly increased incidence of ST-T changes after ICIs treatment (31.0% (27/87) vs. 17.2% (15/87), P=0.012), which mainly attributed to the T wave changes (29.9% (26/87) vs. 13.8% (12/87), P=0.001). The incidence of premature contractions was also significantly increased after ICIs treatment (9.2% (8/87) vs. 0, P=0.008). Additionally, compared with baseline, the P wave axis was significantly increased after ICIs treatment ((56.94±21.01)° vs. (52.00±22.69)°, P=0.043). After ICIs treatment, the heart rate was significantly increased ((79.07±15.37) beats/min vs. (75.64±13.37) beats/min, P=0.029). Sokolow-Lyon index ((2.21±0.81)mV vs. (2.33±0.75)mV, P=0.138), QTc interval ((431.44±36.04)ms vs. (428.00±30.05)ms, P=0.415) all showed signs of change after treatment, but did not reach the traditional significant level. Conclusions: The incidence of abnormal ECG is significantly increased after ICIs treatment, especially for sinus tachycardia, premature contractions and T wave changes; the P wave axis and heart rate is also significantly increased after treatment. It is important to perform regular ECG monitoring in patients receiving ICIs treatment.

目的: 分析肿瘤患者使用免疫检查点抑制剂(ICI)后心律失常发生情况及心电图特征的变化。 方法: 本研究为一项队列研究,选取2020年11月至2022年9月于河北医科大学第四医院接受ICI治疗的肿瘤患者,对其接受ICI治疗前后的标准12导联心电图进行分析比较。其中,出现窦性心律失常、心房颤动、心房扑动、阵发性室上性心动过速、室性心动过速、早搏、传导阻滞、ST-T改变等异常心电现象中任何1种,则该份心电图被定义为异常心电图。 结果: 共纳入87例患者,年龄63(57,68)岁,男性66例(75.9%)。44.8%(39/87)的患者在接受ICI治疗前即存在至少1种心血管疾病或危险因素。在接受(5.0±2.7)个周期的ICI治疗后,与基线水平比较,异常心电图发生率升高[65.5%(57/87)比31.0%(27/87),P<0.001];ICI治疗后窦性心律失常发生率高于基线[23.0%(20/87)比9.2%(8/87),P=0.023],其中,以窦性心动过速患者的比例升高为著[11.5%(10/87)比2.3%(2/87),P=0.039]。ICI治疗后心电图出现ST-T改变的患者比例高于基线[31.0%(27/87)比17.2%(15/87),P=0.012],主要归因于T波改变的发生率升高[29.9%(26/87)比13.8%(12/87),P=0.001]。此外,ICI治疗后早搏的发生率较治疗前升高[9.2%(8/87)比0,P=0.008]。心电图各指标中,接受ICI治疗后患者的P波电轴较基线增大[(56.94±21.01)°比(52.00±22.69)°,P=0.043],静息心率较前升高[(79.07±15.37)次/min比(75.64±13.37)次/min,P=0.029];Sokolow-Lyon指数较基线有下降趋势[(2.21±0.81)mV比(2.33±0.75)mV,P=0.138],QTc间期较基线有延长趋势[(431.44±36.04)ms比(428.00±30.05)ms,P=0.415]。 结论: 肿瘤患者在接受ICI治疗后异常心电图的发生率升高,其中主要以窦性心动过速、T波改变、早搏的发生率增高为主,心电图P波电轴在治疗后增大、静息心率加快,提示对于接受ICI治疗的肿瘤患者,进行规律的心电监测十分重要。.

Publication types

  • English Abstract

MeSH terms

  • Aged
  • Arrhythmias, Cardiac* / chemically induced
  • Arrhythmias, Cardiac* / epidemiology
  • Cohort Studies
  • Electrocardiography*
  • Female
  • Humans
  • Immune Checkpoint Inhibitors* / adverse effects
  • Incidence
  • Male
  • Middle Aged
  • Neoplasms* / drug therapy
  • Risk Factors


  • Immune Checkpoint Inhibitors