放射治疗（RT）与长期心脏毒性有关。在临床前模型中，RT暴露导致早期心律失常，包括心房颤动（AF）。然而，是否发生在患者身上尚不清楚。利用2007年至2019年间连续接受胸部放射治疗的食管癌患者大样本队列，我们评估了发生AF的发病率和结果。次要结果包括主要不良心血管事件（MACE），定义为AF、心力衰竭、室性心律失常和猝死，并与心脏RT剂量相关。我们还评估了AF发展与无进展生存期和总生存期之间的关系。观察到的AF发生率与弗雷明汉预测率进行了比较，并估计了绝对过高风险（AER）。采用多变量回归定义了临床和RT测量与结果之间的关系。还通过30天里程碑分析评估了不同AF状态下的结果差异。此外，我们还评估了心脏细分结构放射治疗剂量（例如左心房，LA）对RT相关结果风险的影响。 总体而言，238名接受RT治疗的食管癌患者中有21.4%发生了AF事件，33%发生了MACE，其中大多数事件（84%）发生在RT开始后的≤2年内；AF的中位发生时间为4.1个月。1年时的AF和MACE的累积发生率分别为19.5%和25.7%，这相当于每10,000年人观察的AF发生率为824，而弗雷明汉预测率为92（RR 8.96，P<0.001，AER 732）。左心房剂量的增加与AF事件强烈相关（P=0.001）；患有AF的患者疾病进展较差（HR=1.54，P=0.03）。在多变量模型中，除了传统癌症相关因素之外，增加RT剂量至左心房仍然与整体生存较差相关。 在食管癌患者中，放射治疗会增加AF的风险，并与较差的长期结果相关。 版权所有 © 2023. 由Elsevier Inc.出版。

Radiotherapy (RT) associates with long-term cardiotoxicity. In preclinical models, RT-exposure induces early cardiotoxic arrhythmias including atrial fibrillation (AF). Yet, whether this occurs in patients is unknown.Leveraging a large cohort of consecutive esophageal cancer patients treated with thoracic-RT from 2007-2019, we assessed incidence and outcomes of incident-AF. Secondary outcomes included major adverse cardiovascular events (MACE), defined as AF, heart failure, ventricular-arrhythmias and sudden-death, by cardiac RT-dose. We also assessed the relationship between AF-development and progression-free and overall-survival. Observed incident-AF rates were compared with Framingham predicted-rates, and absolute-excess-risks (AER) were estimated. Multivariate-regression was used to define the relationship between clinical and RT-measures, and outcomes. Differences in outcomes, by AF-status, were also evaluated via 30-day landmark-analysis. Furthermore, we assessed the effect of cardiac substructure RT-dose (ex. left atrium, LA) on the risk of post RT-related outcomes.Overall, from 238 RT-treated esophageal cancer patients, 21.4% developed incident-AF, and 33% developed MACE, with the majority (84%) of events occurring ≤2 years of RT-initiation; median time-to-AF, 4.1 months. Cumulative incidence of AF and MACE at 1-year was 19.5%, and 25.7%, respectively; translating into an observed incident-AF rate of 824 per 10,000 person-years, compared to the Framingham predicted-rate of 92 (RR 8.96, P<0.001, AER 732). Increasing LA dose strongly associated with incident-AF (P=0.001); and those with AF saw worse disease-progression (HR=1.54, P=0.03). In multivariate-models, outside of traditional cancer-related factors, increasing RT-dose to the LA remained associated with worse overall-survival.Among esophageal cancer patients, radiotherapy increases AF-risk, and associates with worse long-term outcomes.Copyright © 2023. Published by Elsevier Inc.