# Prediction of Cardiac Arrhythmias in Cancer Patients Treated with Immune Checkpoint Inhibitors Using Electrocardiogram

## TL;DR

This study examines whether ECG markers can predict arrhythmias in cancer patients treated with immune checkpoint inhibitors, finding no significant changes in these markers over time.

## Contribution

The study provides new insights into the cardiovascular safety of immune checkpoint inhibitors using serial ECG monitoring in cancer patients.

## Key findings

- No significant changes in ECG parameters were observed during ICI treatment.
- Only minor arrhythmias were reported, with no malignant ventricular arrhythmias.
- Larger studies are needed to confirm the cardiovascular safety of ICIs.

## Abstract

Background/Objectives: Immune checkpoint inhibitor (ICI)-associated cardiovascular adverse events are relatively uncommon; they can be life-threatening, particularly when involving malignant ventricular arrhythmias. Electrocardiographic markers such as P-wave dispersion (PWD), QT dispersion (QTd), T-peak to T-end (Tp-e) interval, and Tp-e/QT and Tp-e/QTc ratios have been linked to an elevated risk of both atrial and ventricular arrhythmias and sudden cardiac death across various cardiac conditions. Monitoring these parameters may aid in identifying the risk of arrhythmogenic events in cancer patients undergoing ICI therapy. Methods: This retrospective cohort study analyzed 42 patients with cancer who received ICI therapy and had serial 12-lead electrocardiograms (ECGs) performed at baseline and at three-month intervals during the first year of treatment, from May 2022 to November 2023. ECG parameters including PWD, QTd, Tp-e interval, and Tp-e/QT and Tp-e/QTc ratios were measured and compared between baseline and follow-up time points. Results: The median follow-up duration was 5.3 months (range: 0.5–18.9 months). No statistically significant differences were observed in any of the ECG parameters between baseline and subsequent measurements (p > 0.05). One patient developed atrial fibrillation during the third month of treatment. Additionally, one patient exhibited a left anterior fascicular block, and another experienced frequent ventricular extrasystoles. No malignant ventricular arrhythmias were reported throughout the study period. Conclusions: This study found no significant changes in electrocardiographic markers associated with arrhythmia risk during ICI treatment. Larger, multicenter, prospective studies with extended follow-up are warranted to further elucidate the cardiovascular safety profile of ICIs.