This 2025 EHRA position paper addressed the contemporary management of AF in patients with cancer, providing practical guidance for the complex decisions around anticoagulation, rate/rhythm control, and drug interactions in this dual-disease population.
This study aimed to assess current clinical practices in the diagnosis and management of atrial fibrillation (AF) among patients with active cancer or a history of cancer therapy.
A 25-item, physician-based survey was developed by the European Heart Rhythm Association in collaboration with the European Society of Cardiology Council of Cardio-Oncology and the International Cardio-Oncology Society. The survey was disseminated electronically. A total of 380 participants from 74 countries completed the questionnaire, with respondents primarily working as electrophysiologists (30%), general cardiologists (25%), and cardio-oncologists (22%). Nearly two-thirds reported that active cancer 'definitely' or 'most probably' influenced clinical decisions regarding AF diagnosis and management. When AF was diagnosed, rhythm control was the preferred management strategy for symptomatic patients, while rate control was favoured for asymptomatic individuals. A little over 40% reported that a history of cancer therapy 'definitely' or 'most probably' influenced clinical decisions regarding AF. The rhythm control was the most common strategy (40%). In both populations, opportunistic screening for AF and direct oral anticoagulants (DOACs) were preferred strategies. A high level of uncertainty was noted concerning the role of invasive treatment options.
The survey revealed that, despite the lack of robust evidence specific to this patient cohort, contemporary treatment of AF in patients with active cancer or a history of cancer therapy generally follows guidelines developed for the broader AF population. These findings highlight the urgent need for more dedicated data to inform clinical decision-making in cardio-oncology patients with AF.
