Immune checkpoint inhibitor-associated arrhythmias: clinical challenges, artificial intelligence-enhanced monitoring, and management strategies

Immune checkpoint inhibitors (ICIs) have revolutionized the therapeutic landscape for a broad spectrum of malignancies, substantially prolonging patient survival. However, the widespread clinical adoption of ICIs is challenged by a diverse array of cardiovascular immune-related adverse events (CV-irAEs). Among these, arrhythmias pose a considerable threat to patient safety and treatment continuity, given their insidious onset and potential lethality. Traditionally, these arrhythmias have been largely conceptualized as secondary complications of ICI-induced myocarditis, a perspective that has obscured their true clinical features. Emerging evidence indicates that ICI-associated arrhythmias exhibit distinct risk profiles and pathogenic mechanisms, suggesting that arrhythmias may be substantially more common than previously recognized and frequently manifest as standalone clinical entities rather than mere secondary complications. Accordingly, to mitigate cardiovascular risk and optimize long-term patient outcomes, this review synthesizes the epidemiology, risk factors, pathogenesis, and management strategies of ICI-associated arrhythmias, while highlighting the transformative potential of artificial intelligence-enhanced monitoring in advancing precision cardio-oncology.