The incidence of atrial fibrillation with trastuzumab treatment: A systematic review and meta-analysis

Aim: Cases of cardiotoxicity related to trastuzumab have been reported. This systematic review and meta-analysis evaluated the risk of atrial fibrillation (AF) in patients of breast cancer treated with trastuzumab. Methods: PubMed and EMBASE were searched until September 2017 for articles that investigated AF incidence in patients receiving trastuzumab for breast cancer. Results: A total of 15 studies involving 8124 patients treated with trastuzumab were included. Of the total cohort, 37 patients suffered from AF, giving rise to an incidence of 1.22% (95% confidence interval [CI]: 0.56%-2.68%). No significant difference in the incidence of AF was found between ado-trastuzumab emtansine (0.95%, 95% CI: 0.36%-2.52%) and trastuzumab groups (1.32%, 95% CI: 0.52%-3.34%), trastuzumab combined with other antineoplastic agents (2.09%, 95% CI: 1.16%-3.73%) and trastuzumab alone (0.36%, 95% CI: 0.04%-3.08%), prior exposure to anthracyclines (1.72%, 95% CI: 0.75%-3.88%) and no prior exposure (1.03%, 95% CI: 0.30%-3.51%), and radiotherapy (1.26%, 95% CI: 0.68%-2.33%) vs. no radiotherapy (1.21%, 95% CI: 0.35%-4.14%). Conclusions: Atrial fibrillation incidence in breast cancer patients receiving trastuzumab was around 1.2%. It was not influenced by the formulation of trastuzumab, the additional use of neoplastic agents, anthracycline exposure status, or concurrent radiotherapy.