RT Journal Article
SR Electronic
T1 High incidence of atrial fibrillation in patients treated with ibrutinib
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e001049
DO 10.1136/openhrt-2019-001049
VO 6
IS 1
A1 Florian Baptiste
A1 Jennifer Cautela
A1 Yan Ancedy
A1 Noémie Resseguier
A1 Thérèse Aurran
A1 Laure Farnault
A1 Marion Escudier
A1 Chloé Ammar
A1 Mélanie Gaubert
A1 Charles Dolladille
A1 Jeremie Barraud
A1 Michael Peyrol
A1 Ariel Cohen
A1 Franck Paganelli
A1 Joachim Alexandre
A1 Stephane Ederhy
A1 Franck Thuny
YR 2019
UL http://openheart.bmj.com/content/6/1/e001049.abstract
AB Objective Atrial fibrillation (AF) is one of the most common side effects of ibrutinib, a drug that has dramatically improved the prognosis of chronic B-cell malignancies such as chronic lymphocytic leukaemia (CLL). The true incidence of ibrutinib-related AF (IRAF) is not well known and its therapeutic management poses unique challenges especially due to the inherent risk of bleeding. We aimed to determine the incidence and predictors of IRAF, and to analyse its management and outcome.Methods A standardised monitoring was applied at two cardio-oncology clinics in consecutive patients referred before and during ibrutinib therapy. The primary endpoint was the incidence of IRAF. The excess of AF incidence with ibrutinib was studied by comparing the incidence of IRAF with the expected incidence of AF in general population and in patients with CLL not exposed to ibrutinib.Results 53 patients were included. The incidence of IRAF was 38% at 2 years and the risk was 15-fold higher than the AF risk in both the general population and patients with CLL not exposed to ibrutinib (p<0.0001). The majority of cases occurred in asymptomatic patients within the first 6 months. Left atrial volume index ≥40 mL/m2 at treatment initiation identified patients at high risk of developing IRAF. No major bleeding events occurred in patients on ibrutinib, although the majority of patients with IRAF were treated with anticoagulants.Conclusions This cardio-oncology study showed that the risk of IRAF was much higher than previously reported. The majority of cases occurred in asymptomatic patients justifying close monitoring.