Abstract
Introduction: Ibrutinib, a Bruton's tyrosine kinase inhibitor (TKI) used primarily in the treatment of hematologic malignancies, has been associated with increased incidence of atrial fibrillation (AF), with limited data on its association with other tachyarrhythmias. There are limited reports that comprehensively analyze atrial and ventricular arrhythmia (VA) burden in patients on ibrutinib. We hypothesized that long-term event monitors could reveal a high burden of atrial and VAs in patients on ibrutinib.Methods: A retrospective data analysis at a single center using electronic medical records database search tools and individual chart review was conducted to identify consecutive patients who had event monitors while on ibrutinib therapy.Results: Seventy-two patients were included in the analysis with a mean age of 76.9 ± 9.9 years and 13 patients (18%) had a diagnosis of AF prior to the ibrutinib therapy. During ibrutinib therapy, most common arrhythmias documented were non-AF supraventricular tachycardia (n = 32, 44.4%), AF (n = 32, 44%), and non-sustained ventricular tachycardia (n = 31, 43%). Thirteen (18%) patients had >1% premature atrial contraction burden; 16 (22.2%) patients had >1% premature ventricular contraction burden. In 25% of the patients, ibrutinib was held because of arrhythmias. Overall 8.3% of patients were started on antiarrhythmic drugs during ibrutinib therapy to manage these arrhythmias.Conclusions: In this large dataset of ambulatory cardiac monitors on patients treated with ibrutinib, we report a high prevalence of atrial and VAs, with a high incidence of treatment interruption secondary to arrhythmias and related symptoms. Further research is warranted to optimize strategies to diagnose, monitor, and manage ibrutinib-related arrhythmias.
Highlights
Ibrutinib, a Bruton’s tyrosine kinase inhibitor (TKI) used primarily in the treatment of hematologic malignancies, has been associated with increased incidence of atrial fibrillation (AF), with limited data on its association with other tachyarrhythmias
Of 755 patients who were on ibrutinib therapy for hematologic malignancies at Stanford Hospital between 2014 and 2019, 72 patients had event monitors (Zio, iRhythm Technologies, Inc., CA) while on ibrutinib therapy and were included in this analysis (Table 1)
Thirteen (18%) patients had a history of Atrial fibrillation (AF) prior to initiation of ibrutinib
Summary
A Bruton’s tyrosine kinase inhibitor (TKI) used primarily in the treatment of hematologic malignancies, has been associated with increased incidence of atrial fibrillation (AF), with limited data on its association with other tachyarrhythmias. The use of ibrutinib has been associated with increased incidence of AF [5]; with limited data on its association with other arrhythmias These arrhythmias lead to a relatively high treatment interruption rate and cause significant morbidity in this patient population [4]. There are limited data to date that comprehensively analyze both atrial and ventricular arrhythmia (VA) burden in patients on ibrutinib, and subsequent referral to subspecialty care, antiarrhythmic drug use, and treatment interruption patterns. We hypothesized that longterm event monitors, as defined by continuous ECG monitoring >48 h, could reveal a high burden of atrial and VAs in patients on ibrutinib therapy which may lead to treatment cessation
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