Background: Chemotherapy-related cardiac dysfunction (CTRCD) remains a critical limitation of cancer therapy, with implications for morbidity and survivorship. Echocardiography is the established surveillance tool, while electrocardiography (ECG) may offer earlier, low-cost detection of subclinical cardiotoxicity. The relative diagnostic yield of these modalities is uncertain. Aim: To systematically review and compare echocardiography and ECG for early detection of CTRCD in patients receiving cancer therapy. Methods: Following PRISMA 2020 guidelines, PubMed, Embase, Scopus, and CENTRAL were searched through May 2025. Eligible studies included prospective or retrospective cohorts reporting echocardiographic and ECG outcomes in adults undergoing chemotherapy. Data on left ventricular ejection fraction (LVEF), diastolic function, global longitudinal strain (GLS), and ECG abnormalities were extracted. Pooled incidence and effect estimates were calculated using random-effects models. Risk of bias was assessed with QUADAS-2. Results: Thirteen cohort studies involving 937 patients were included. The pooled incidence of echo-defined CTRCD was 10% (95% CI 7–16%), with higher rates among anthracycline-treated cohorts. Diastolic dysfunction and GLS reduction occurred in up to 40% of patients, frequently preceding a decline in LVEF. ECG abnormalities were observed in 35% (95% CI 22–49%), most commonly QTc prolongation, ST–T changes, fragmented QRS, and atrial fibrillation. Routine ECG demonstrated low sensitivity compared with echocardiography, though continuous monitoring and AI-enhanced ECG showed potential for earlier detection. Conclusions: Echocardiography remains the cornerstone for CTRCD surveillance, with GLS and diastolic indices providing early warning. ECG abnormalities are frequent but inconsistent predictors; their role may expand with continuous and AI-based approaches. A multimodal surveillance strategy integrating echo and advanced ECG may improve cardio-oncology care.

Background Pulsed field ablation (PFA) is an emerging non-thermal modality for atrial fibrillation (AF) that promises tissue selectivity and reduced complications compared with conventional thermal ablation (radiofrequency or cryoballoon). However, long-term efficacy remains uncertain. This Bayesian meta-analysis and systematic review synthesizes randomized and prospective data, incorporating Monte Carlo simulations to evaluate evidence robustness—a novel approach to assess statistical fragility in AF ablation trials. Methods Following PRISMA guidelines and PROSPERO registration (CRD420251146923), we searched PubMed, Embase, and other databases through August 2025 for studies comparing PFA with thermal ablation in adults with paroxysmal or persistent AF. Primary outcome was 12-month treatment success (freedom from arrhythmia, antiarrhythmic drugs, cardioversion, or repeat ablation). Secondary outcomes included arrhythmia recurrence (>30 seconds post-blanking), repeat ablation, procedure time, and safety (adverse events). We employed frequentist and Bayesian random-effects models with non-informative priors, alongside Monte Carlo simulations (5000–10,000 iterations) to estimate trial power and meta-analytic success probabilities under varying heterogeneity. Results From 5 studies (n=1,234 patients), PFA showed higher odds of 12-month treatment success (Bayesian mean OR 1.63, 95% CrI 1.02–2.60) and a trend toward reduced recurrence (OR 0.61, 95% CrI 0.34–1.09), with shorter procedure times (mean difference –24.2 minutes, 95% CrI –42.4 to –6.1) and comparable safety (overall adverse events OR 1.22, 95% CrI 0.50–2.96). Heterogeneity was moderate (I 2 48–60%). Simulations revealed individual trials (n=300/arm) are underpowered (~66% power), but meta-analyses achieve 27–70% success probability, emphasizing aggregation’s value. Conclusions PFA demonstrates non-inferior efficacy to thermal ablation with superior procedural efficiency and equivalent safety, potentially transforming AF management. Monte Carlo insights highlight the need for larger trials, positioning PFA as a clinically efficient rhythm control strategy.