Rhythm Control in Chemotherapy-Related Atrial Fibrillation: A Propensity-Matched Comparison of Pulmonary Vein Isolation and Antiarrhythmic Drugs

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Chemotherapy is strongly associated with atrial fibrillation (AF). Long-term real-world studies comparing rhythm control strategies, specifically pulmonary vein isolation (PVI) and antiarrhythmic drugs (AADs), in chemotherapy-related AF are limited. METHODS We used to identify adults with chemotherapy-related AF (new-onset AF within one year of starting anticancer therapy). Patients were categorized based on their rhythm control strategy: PVI versus AAD. Propensity score matching (PSM) was applied to adjust for demographics, medical comorbidities, malignancy types, and chemotherapy agents. Five-year outcomes included all-cause mortality, all-cause readmission, heart failure (HF) exacerbation, and ischemic stroke. RESULTS Among 5,933 eligible patients, 2.5% underwent PVI. After PSM, 144 patients were in the PVI group (age 70.7 ± 7.6 years; 30.6% female); 144 received AADs (age 71.6 ± 10.5 years; 24.3% female). Over five years of follow-up, PVI was associated with lower risks of all-cause mortality (9.7% vs. 43.1%), all-cause readmission (56.3% vs. 66.7%), and HF exacerbation (24.3% vs. 42.4%) than the AAD group (all P< 0.01). The risk of ischemic stroke was similar between the two groups, with 7.6% in each (P=0.21). CONCLUSION This is the first study to demonstrate a significant reduction in long-term clinical outcomes in patients with chemotherapy-related AF treated with PVI compared to those treated with AADs.

Volume

87

Issue

13 Suppl

First Page

A1110

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1110

DOI

10.1016/j.jacc.2026.02.2722

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