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Ibrutinib-Associated Atrial Fibrillation.

Sarju Ganatra1, Ajay Sharma2, Sachin Shah2

  • 1Cardio-Oncology Program, Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts.

JACC. Clinical Electrophysiology
|December 22, 2018
PubMed
Summary

Ibrutinib treatment for B-cell lymphomas increases atrial fibrillation (AF) risk significantly. Management requires careful consideration of drug interactions and bleeding risks.

Keywords:
B-cell lymphomaanticoagulationatrial fibrillationibrutinib

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Area of Science:

  • Oncology
  • Cardiology
  • Pharmacology

Background:

  • Ibrutinib is an effective Bruton tyrosine kinase inhibitor for B-cell lymphomas.
  • Ibrutinib use is linked to an increased incidence of atrial fibrillation (AF), reported between 4% and 16%.

Purpose of the Study:

  • To assess the incidence of ibrutinib-associated atrial fibrillation (AF).
  • To review management challenges and propose an algorithm for ibrutinib-associated AF.

Main Methods:

  • Review of original clinical trials and other prospective/retrospective studies.
  • Meta-analysis of 16 studies to determine ibrutinib-associated AF incidence.

Main Results:

  • The incidence of ibrutinib-associated AF was 5.77 per 100 person-years, higher than previously reported and the general population.
  • New-onset AF in cancer patients correlates with increased risk of heart failure and thromboembolism.
  • Ibrutinib interacts with common AF medications, complicating management and increasing toxicity risks.

Conclusions:

  • Ibrutinib-associated AF is a significant concern with a higher incidence than previously understood.
  • Management necessitates careful consideration of drug interactions, anticoagulation, and bleeding risks.
  • Physicians need to be aware of special management considerations for ibrutinib-associated AF.