Supplementary Material for: Cardiac Arrhythmias Associated with Brain Tumors: A Systematic Review

Introduction:
Brain tumors may disrupt cardiac autonomic regulation, leading to arrhythmias that complicate patient management. This review aims to synthesize evidence on the relationship between brain tumor characteristics, treatments, and cardiac arrhythmias.
Methods:
A systematic literature search was performed with independent screening and data extraction by two reviewers. Due to heterogeneity in study designs, tumor types, and arrhythmia outcomes, quantitative meta-analysis was not feasible; results were synthesized qualitatively.
Results:
Supratentorial tumors, especially in limbic and insular regions, were frequently associated with atrial arrhythmias and ECG abnormalities. High-grade tumors showed diverse arrhythmias, including bradycardia and ventricular events, often linked to tumor progression or seizures. Surgical resection improved arrhythmias but posed perioperative risks, notably with right insular involvement. Chemotherapy effects were variable; radiation-induced arrhythmias were infrequent and dose-dependent. Arrhythmia patterns varied across pre-, peri-, and post-treatment phases, reflecting complex neurocardiac interactions.
Conclusion:
Cardiac arrhythmias in brain tumor patients arise from multifactorial mechanisms influenced by tumor biology and treatment effects. Prospective, standardized studies are required to clarify underlying mechanisms and optimize arrhythmia management in neuro-oncology.

引言：脑肿瘤可能会扰乱心脏自主神经调节，进而引发心律失常，增加患者临床诊疗管理的复杂度。本综述旨在综合分析脑肿瘤特征、治疗方案与心律失常之间的关联证据。
方法：本研究开展了系统性文献检索（systematic literature search），由两名评审员独立完成文献筛选与数据提取工作。由于研究设计、肿瘤类型及心律失常结局存在异质性，无法进行定量荟萃分析（meta-analysis），最终采用定性综合的方式呈现研究结果。
结果：幕上肿瘤（Supratentorial tumors），尤其是位于边缘叶与岛叶区域者，常与房性心律失常及心电图异常相关。高级别脑肿瘤（high-grade tumors）可引发多种心律失常，包括心动过缓（bradycardia）与室性事件（ventricular events），且多与肿瘤进展或癫痫发作相关。手术切除可改善心律失常状况，但存在围手术期风险（perioperative risks），尤以累及右侧岛叶时最为显著。化疗（chemotherapy）的影响存在个体差异；放射治疗诱导的心律失常（radiation-induced arrhythmias）较为少见，且呈剂量依赖性。心律失常的表现在治疗前、围手术期及治疗后各阶段存在差异，反映了复杂的神经心脏相互作用（neurocardiac interactions）。
结论：脑肿瘤患者的心律失常由多因素机制介导，受肿瘤生物学特性与治疗干预的共同影响。未来需开展前瞻性、标准化研究，以阐明其潜在发病机制，并优化神经肿瘤学（neuro-oncology）领域的心律失常管理方案。