Atrial Fibrillation and Cancer: Bidirectional Relationship and Potential for Personalized Care

Udhayvir S Grewal; Stefano H Byer; Sidharth Mahajan; Aakash R Sheth; Kavitha Beedupalli; Michael G Fradley; Eric H Yang; Andrea M Russo; Aarti Asnani; Paari Dominic

doi:10.1016/j.jacep.2025.09.044

Atrial Fibrillation and Cancer: Bidirectional Relationship and Potential for Personalized Care

JACC Clin Electrophysiol. 2025 Oct 28:S2405-500X(25)00815-1. doi: 10.1016/j.jacep.2025.09.044. Online ahead of print.

Authors

Affiliations

¹ Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
² Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
³ Department of Internal Medicine, MacNeal Hospital, Loyola Medicine, Chicago, Illinois, USA.
⁴ Department of Cardiology, University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA.
⁵ Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
⁶ Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁷ Cardio-Oncology Program, Division of Cardiology, University of California Los Angeles Health, Los Angeles, California, USA.
⁸ Cooper Medical School of Rowan University, Camden, New Jersey, USA.
⁹ Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
¹⁰ Division of Cardiology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Electronic address: paari-dominic@uiowa.edu.

PMID: 41182206
DOI: 10.1016/j.jacep.2025.09.044

Abstract

A bidirectional relationship between cancer and atrial fibrillation (AF) is well known. Although systemic inflammation and the effects of cancer treatment significantly increase the risk of AF in patients with cancer, new-onset AF has also been shown to independently predict the risk of active malignancy. With a continued growth in our understanding of the molecular pathogenesis of AF and with the advent of novel anticancer agents with unique cardiotoxic effects, there is a need to study if the management of AF in patients with cancer requires a more "personalized" approach rather than a generalized approach. The current review focuses on the application of "precision cardio-oncology" to the screening, diagnosis, and management of AF in patients with cancer through biomarkers, cardiac imaging, and personalized risk stratification. Through this review, we highlight the growing need to incorporate personalized interventions into clinical studies and analyze the feasibility of integrating these into the routine care of patients with cancer.

Keywords: atrial fibrillation; cancer; cardio-oncology.

Publication types

Review