Accepted for/Published in: JMIR Research Protocols
Date Submitted: Oct 23, 2024
Date Accepted: Mar 24, 2025
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Screening and Risk Analysis of Atrial Fibrillation after Radiotherapy for Breast Cancer: Protocol for a Cross-Sectional Cohort Study (Watch Your HeaRT – WATCH study)
ABSTRACT
Background:
Post-radiotherapy atrial fibrillation (AF) in breast cancer (BC) patients is a relatively new and understudied topic. AF can increase the risk of stroke and other serious cardiovascular complications, compromising patients' quality of life and survival. Detection of AF, both asymptomatic and symptomatic forms, is therefore essential for optimal management.
Objective:
The aim of the WATCH study is to assess the incidence of AF (symptomatic or asymptomatic) occurring throughout a 5-years follow-up after RT and to investigate whether cardiac radiation exposure is associated with the occurrence of such events.
Methods:
WATCH is a cohort study that will include 200 patients over 65 years old, treated with radiotherapy for BC five years before inclusion, without history of AF. Cross-sectional screening for AF at the time of the scheduled five-year post-radiotherapy visit is conducted by recording data from a Withings ScanWatch smartwatch for one month, confirmed by an ECG, and validated by a physician. In addition, a transthoracic echocardiography is performed, providing comprehensive assessment of cardiac structures, and allowing to investigate underlying etiology and assess the risk of complications. Patient's medical record provides retrospective information on the timing and risk factors for the occurrence of AF and other arrhythmias and cardiac diseases during the 5 years following RT. The development of deep learning algorithms for auto-segmentation analysis of potentially critical sub-structures for the occurrence of AF, including cardiac chambers, sinoatrial node, atrioventricular node, coronary arteries, pulmonary veins, will produce dosimetry linked to previous radiotherapy treatment for all contoured structures.
Results:
The inclusions started in October 2023 and will continue until mid-2026 to include 200 patients. The results are expected by the end of 2026.
Conclusions:
This study will contribute to generating new knowledge on AF after radiotherapy for BC, and help considering AF screening into routine clinical practice in these patients. Identifying the dose-risk associations would improve RT delivery protocols to limit the occurrence of these arrhythmias and, if necessary, initiate appropriate treatment. Clinical Trial: ClinicalTrials.gov:NCT06073509. Registration date: 10/09/2023
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