Abstract 13833: Arrhythmia Patterns in Patients Managed With and Without Tyrosine Kinase Inhibitors

Abstract

Introduction: Tyrosine kinase inhibitors (TKIs) are often used to treat hematologic malignancies. Ibrutinib, a Bruton’s TKI, has been associated with increased burden of treatment limiting arrhythmias. How this compares to arrhythmias in patients on non-ibrutinib TKIs or non-TKI therapy is unknown. Hypothesis: We hypothesized that ibrutinib therapy would be associated with higher atrial and ventricular arrhythmia burden than non-ibrutinib TKI or non-TKI therapies in patients with hematologic malignancies. Methods: We performed a retrospective single center chart review of consecutive patients who received 14-day cardiac event monitors while on ibrutinib, non-ibrutinib TKIs, or non-TKI therapy for a hematologic malignancy between 2014-2021. Results: A total of 176 patients were included (ibrutinib=72, non-ibrutinib TKI=36, non-TKI=68; Figure A). The ibrutinib group had higher incidence of AF (n=32, 44%) and NSVT (n=31, 43%) than the non-ibrutinib TKI (AF: n=7, 19%, p=0.02; NSVT: n=8, 22%, p=0.03) and non-TKI group (AF: n=13, 19%, p=0.003; NSVT: n=14, 21%, p=0.006; Figure B). Rates of SVT, PAC burden, and PVC burden were not significantly different. Therapy was held in 25% (n=18) of patients on ibrutinib vs 5% (n=2) on non-ibrutinib TKIs. Average duration of TKI therapy was 32 months in the ibrutinib group vs 77 months in the non-ibrutinib group (p<0.001). Of note, the non-TKI group had significantly higher outpatient cardiology follow-up versus the TKI groups (p=0.048). Conclusions: In this large retrospective comparison of cardiac event monitors in patients with hematologic malignancies on ibrutinib, non-ibrutinib TKIs, or non-TKI therapy, those receiving ibrutinib had a higher incidence of atrial and ventricular arrhythmias and higher rate of treatment interruption due to arrhythmia burden but less cardiology follow-up. Further research is needed to optimize risk stratification, surveillance, and management of TKI-related arrhythmias.