The article reviews the mechanisms and cardiotoxic effects of immune checkpoint inhibitors (ICIs) and explores emerging options for next-generation ICIs. ICIs, such as CTLA-4, PD-1, PD-L1, and LAG-3 inhibitors, have revolutionized cancer treatment by enhancing anti-tumor responses. However, they also cause immune-related adverse events (irAEs), particularly in the cardiovascular system, including myocarditis, atherosclerosis, pericarditis, arrhythmias, and cardiomyopathy. The review highlights the mechanisms behind these cardiac toxicities, focusing on myocarditis and atherosclerosis. It also discusses the use of ICIs in cancer treatment, supported by preclinical and clinical data. Additionally, the article examines the potential of next-generation ICIs targeting Tim-3 and TIGIT, which show promise in treating solid tumors and are currently under active investigation. The review emphasizes the importance of comprehensive exploration and management of cardiovascular irAEs associated with ICIs to ensure safe and effective cancer therapy.The article reviews the mechanisms and cardiotoxic effects of immune checkpoint inhibitors (ICIs) and explores emerging options for next-generation ICIs. ICIs, such as CTLA-4, PD-1, PD-L1, and LAG-3 inhibitors, have revolutionized cancer treatment by enhancing anti-tumor responses. However, they also cause immune-related adverse events (irAEs), particularly in the cardiovascular system, including myocarditis, atherosclerosis, pericarditis, arrhythmias, and cardiomyopathy. The review highlights the mechanisms behind these cardiac toxicities, focusing on myocarditis and atherosclerosis. It also discusses the use of ICIs in cancer treatment, supported by preclinical and clinical data. Additionally, the article examines the potential of next-generation ICIs targeting Tim-3 and TIGIT, which show promise in treating solid tumors and are currently under active investigation. The review emphasizes the importance of comprehensive exploration and management of cardiovascular irAEs associated with ICIs to ensure safe and effective cancer therapy.