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Ibrutinib-related atrial fibrillation: Therapeutic challenges

Chris J Kapelios1, Maria S Bonou1, Panagiotis Diamantopoulos2

  • 11 Department of Cardiology, Laiko General Hospital, Athens, Greece.

Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners
|July 18, 2018
PubMed

Insights

Ibrutinib treatment for lymphohyperplastic diseases can cause atrial fibrillation. Intravenous amiodarone successfully restored sinus rhythm in a challenging case, highlighting therapeutic options.

Area of Science:

  • Cardiology
  • Oncology
  • Pharmacology

Background:

  • Ibrutinib is a Bruton's tyrosine kinase inhibitor used for lymphoproliferative disorders.
  • Ibrutinib therapy is linked to an increased risk of atrial fibrillation (AF).
  • Managing new-onset AF in patients on ibrutinib presents therapeutic challenges due to contraindications for certain antiarrhythmics and anticoagulation limitations.

Purpose of the Study:

  • To describe the management of a patient with ibrutinib-associated new-onset atrial fibrillation.
  • To discuss the challenges in rhythm control and anticoagulation for this patient population.

Main Methods:

  • Case report of a 55-year-old patient on ibrutinib presenting with new-onset AF and borderline blood pressure.
  • Attempted rhythm control with intravenous amiodarone when first-line therapies (electrical cardioversion, ablation) were not feasible.

Main Results:

  • Intravenous amiodarone administration led to prompt restoration of sinus rhythm.
  • The patient's borderline arterial pressure was managed during treatment.

Conclusions:

  • Rhythm control with intravenous amiodarone can be effective for ibrutinib-associated AF when first-line options are contraindicated.
  • Careful consideration of anticoagulation and rhythm control strategies is crucial in these complex patients.

Keywords:
Ibrutinibamiodaroneatrial fibrillationcancerleukemia

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