非小细胞肺癌放疗后心律失常很常见。本研究的目的是分析不同心律失常类别与心脏亚结构放疗剂量的关系。对 748 例局部晚期非小细胞肺癌患者进行回顾性分析接受放射治疗。计算心脏亚结构剂量参数。不良事件通用术语标准预测因子的受试者工作特征曲线分析 ≥3 级心房颤动 (AF)、心房扑动、非 AF 和非心房扑动室上性快速心律失常 (SVT)、缓慢性心律失常和室性快速心律失常 (VT) 或计算心搏停止。进行了 Fine-Gray 回归模型（将非心源性死亡作为竞争风险）。在 748 名患者中，128 名患者 (17.1%) 经历过至少 1 次 ≥3 级心律失常，首次心律失常的中位时间为 2.0 年（Q1-Q3： 0.9-4.2 年）。各心律失常组的 2 年累积发生率分别为 AF 8.0%、心房扑动 2.7%、其他 SVT 1.8%、缓慢性心律失常 1.4%、VT 或心搏停止 1.1%。调整基线心血管风险后，接受 5 Gy 的肺静脉 (PV) 容量与 AF 相关（子分布 HR [sHR]：1.04/mL；95% CI：1.01-1.08；P = 0.016），接受 35 Gy 的左回旋支冠状动脉容量与 AF 相关。心房扑动的 Gy（sHR：1.10/mL；95% CI：1.01-1.19；P = 0.028），PV 体积接受 55 Gy 的 SVT（sHR：每 1% 1.03；95% CI：1.02-1.05；P < 0.001 ），右冠状动脉体积接受 25 Gy 的缓慢心律失常（sHR：1.14/mL；95% CI：1.00-1.30；P = 0.042），左主冠状动脉体积接受 5 Gy 的 VT 或心搏停止（sHR：2.45/mL） ；95% CI：1.21-4.97；P = 0.013）。本研究揭示了与离散心脏亚结构的放射治疗剂量相关的病理生理学不同心律失常类别，包括房颤和 SVT 的 PV 剂量、心房扑动的左旋支冠状动脉剂量、右冠状动脉缓慢心律失常的剂量，以及 VT 或心搏停止的左主冠状动脉剂量，指导潜在的风险缓解方法。© 2024 作者。

Arrhythmias are common following radiotherapy for non-small cell lung cancer.The aim of this study was to analyze the association of distinct arrhythmia classes with cardiac substructure radiotherapy dose.A retrospective analysis was conducted of 748 patients with locally advanced non-small cell lung cancer treated with radiotherapy. Cardiac substructure dose parameters were calculated. Receiver-operating characteristic curve analyses for predictors of Common Terminology Criteria for Adverse Events grade ≥3 atrial fibrillation (AF), atrial flutter, non-AF and non-atrial flutter supraventricular tachyarrhythmia (SVT), bradyarrhythmia, and ventricular tachyarrhythmia (VT) or asystole were calculated. Fine-Gray regression models were performed (with noncardiac death as a competing risk).Of 748 patients, 128 (17.1%) experienced at least 1 grade ≥3 arrhythmia, with a median time to first arrhythmia of 2.0 years (Q1-Q3: 0.9-4.2 years). The 2-year cumulative incidences of each arrhythmia group were 8.0% for AF, 2.7% for atrial flutter, 1.8% for other SVT, 1.4% for bradyarrhythmia, and 1.1% for VT or asystole. Adjusting for baseline cardiovascular risk, pulmonary vein (PV) volume receiving 5 Gy was associated with AF (subdistribution HR [sHR]: 1.04/mL; 95% CI: 1.01-1.08; P = 0.016), left circumflex coronary artery volume receiving 35 Gy with atrial flutter (sHR: 1.10/mL; 95% CI: 1.01-1.19; P = 0.028), PV volume receiving 55 Gy with SVT (sHR: 1.03 per 1%; 95% CI: 1.02-1.05; P < 0.001), right coronary artery volume receiving 25 Gy with bradyarrhythmia (sHR: 1.14/mL; 95% CI: 1.00-1.30; P = 0.042), and left main coronary artery volume receiving 5 Gy with VT or asystole (sHR: 2.45/mL; 95% CI: 1.21-4.97; P = 0.013).This study revealed pathophysiologically distinct arrhythmia classes associated with radiotherapy dose to discrete cardiac substructures, including PV dose with AF and SVT, left circumflex coronary artery dose with atrial flutter, right coronary artery dose with bradyarrhythmia, and left main coronary artery dose with VT or asystole, guiding potential risk mitigation approaches.© 2024 The Authors.