DOI: 10.1161/circ.148.suppl_1.16332 ISSN: 0009-7322

Abstract 16332: Atrial Fibrillation Monitoring in Patients on Ibrutinib

Ruchi Patel, Arushi Singh, Zhiying Meng, Abigail Baldridge, Nausheen Akhter
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Ibrutinib increases risk of atrial and ventricular arrythmias, especially atrial fibrillation (AF). No guidelines exist for arrhythmia monitoring, but experts suggest 24h Holter assessments for patients at risk of new or recurring AF or with CHA2DS2-VASc score ≥2. We sought to describe current practices in cardiac event monitoring in high risk or symptomatic patients on ibrutinib.

Methods: We performed a single-center retrospective analysis of 168 ibrutinib-treated patients with no prior AF or atrial flutter (AFL). Patients were followed from 2013 to 2022. Event monitor data was obtained by a single reviewer through chart review.

Results: Among 168 patients followed over a median of 6.4 years, 44 developed AF/AFL (25%) with 31 (70%) with paroxysmal AF. Mean (SD) age at ibrutinib initiation was 66 (11.1) years. Fewer than half (n=50; 30%) were female. Event monitoring was performed for 31 (18.4%) patients, 18 (58%) during treatment and 13 (42%) after treatment completion ( Table 1 ). The most common monitoring reasons were palpitations (10, 32%) and assessing AF burden (9, 29%). Cardiologists outside electrophysiology and cardio-oncology ordered the most monitors (17, 55%). Monitors most captured unspecified SVT (11, 36%) or no significant findings (9, 29%). Monitors most likely resulted in no management changes (19, 61%). The most common management changes were: placement of DC-PM (3, 10%), discontinuing anticoagulation (AC) (3, 10%) and diagnosis of AF (3, 10%). Of note, 14 monitors were done after AF diagnosis of which 7 (50%) showed no AF.

Conclusions: Even with increased risk of arrythmias, use of monitors was low across a cohort of 168 patients. Notably, 3 monitors were used to discontinue AC and 3 monitors found new AF. Recent studies show most AF/AFL in ibrutinib users occurs within the first 6 months of initiation which may inform decisions in screening. Further guidance and standardization are needed for the use of monitors in the ibrutinib population.

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