Risk Factors, Incidence, and Outcomes of Cardiac Arrhythmia Among Autologous Stem Cell Transplant Recipients.

Abstract

Introduction The incidence of arrhythmias during autologous or allogeneic transplant has been reported to be as high as 9–27%. We conducted a retrospective study of only autologous transplant recipients to determine the incidence of arrhythmia, predisposing factors and outcomes in the first 30 days post-transplant. Methods We reviewed 959 charts of autologous transplant recipients between the years 2010-2015 at the University of Kansas. Diagnosis included Multiple Myeloma, Non-Hodgkin's Lymphoma, Hodgkin's Lymphoma, Germ Cell Tumor, and CNS Lymphoma. Results Eighty patients (8%) developed an arrhythmia during the first 30 days of transplant. Atrial Fibrillation was most common accounting for 90% of the cases. Risk factors included age, 51% of patients were 60 years or older. Preexisting conditions included hypertension in 48% and a history of arrhythmia in 34% of the patients. Other precipitating factors included hypokalemia (41%) and neutropenic fever (46%) among those who developed arrhythmia. The was no association between underlying disease or conditioning regimen with the risk of cardiac arrhythmia in our cohort. The median length of hospital stay was prolonged among those with Cardiac arrhythmia which was 20 days compared to a median of 14 patients without arrhythmia, including 11 patients who required ICU transfer. We are working on calculating the overall cost including cardiology consultation incurred by patients with arrhythmia. Conclusion Our study confirms the persistent risk, increased morbidity, and prolonged hospital stay among autologous transplant recipients in the modern transplant era. The main risk factors include age, hypertension, electrolyte imbalance and neutropenic fever. Other studies have shown renal dysfunction as an additional risk factor. Prospective studies are warranted to establish risk models for arrhythmia and effective therapeutic interventions.