Background: Radiotherapy, an essential treatment for numerous malignancies, can lead to radiation-induced heart disease (RIHD), including pericarditis, coronary artery disease, cardiomyopathy, valvular dysfunction, or arrhythmias. Early cardiac monitoring is crucial for timely interventions. Electrocardiography (ECG), a widely available, non-invasive diagnostic tool, provides real-time insights into cardiac electrical activity. However, its utility in detecting and managing RIHD remains underexplored. Materials and Methods: A systematic literature search was performed using PubMed, Embase, and Web of Science, focusing on studies published in English up to 2025 in order to evaluate the role of ECG in monitoring cardiac function in patients undergoing radiotherapy, its diagnostic potential, limitations, and emerging advancements. Results: ECG can detect early signs of RIHD, including ST-segment changes, QT interval prolongation, T-wave abnormalities, and conduction disturbances. While ECG is useful for baseline assessment and ongoing surveillance, its specificity for RIHD-related structural and functional changes is limited. Clinical guidelines recommend ECG as part of routine cardio-oncology care, particularly for high-risk patients. Advancements in wearable devices, such as smartwatches that can measure ECG and artificial intelligence-driven ECG interpretation, may improve early detection, enabling real-time monitoring and improving patient outcomes. Conclusions: ECG allows for early detection and monitoring of RIHD in patients undergoing radiotherapy. Integrating ECG with multimodal imaging and biomarkers can enhance diagnostic accuracy. Future research should focus on refining ECG-based risk stratification models, improving detection algorithms, and optimizing clinical guidelines for cardio-oncology surveillance. Emerging technologies, including AI and remote monitoring, can advance the utility of ECG. |
