Introduction:
Atrial fibrillation often occurs after bone marrow transplant (BMT) and has been shown to increase hospital stay and other morbidity. Treatment can be complicated due to contraindications to anticoagulation therapy. Our objective was to describe the incidence of atrial fibrillation in patients within the first 90 days after BMT and risk predictors for overall mortality.
Methods:
Patients with active malignancy undergoing BMT in 2016 at the Medical College of Wisconsin were included (n=259). Medical records were reviewed for baseline patient characteristics, atrial fibrillation risk factors, incidence of atrial fibrillation, and other complications. Patients were categorized based on survival at 90 days post-BMT. Baseline characteristics and risk factors were analyzed to determine if there was an association with the development of atrial fibrillation and all cause mortality at 90 days.
Results:
Overall, 10.4% developed atrial fibrillation within the first 90 days after BMT. Of those that died before 90 days, 33.3% developed atrial fibrillation compared to 9.6% in those who survived (OR 4.7, 1.11-20.13 p=0.04). Those that died before 90 days were also more likely to have heart failure with reduced ejection fraction, prior radiation therapy (XRT), undergo cardioversion, and to be started on an antiarrhythmic drug (Table 1). When all significant univariate variables were included in a multivariate regression, only XRT was independently predicative of mortality (OR 11.5, 2.4-54.9, p=0.002). The development of atrial fibrillation significantly predicted early mortality (Log Rank p=0.009).
Conclusion:
This analysis demonstrated that the development of atrial fibrillation was predictive of early post-transplant all cause mortality. XRT and antiarrhythmic drug use also significantly predicted mortality. Further studies are required to determine if there is a mortality benefit to the prevention of atrial fibrillation in patients after BMT.
Risk factors for recurrence of atrial fibrillation in patients undergoing hybrid therapy for antiarrhythmic drug-induced atrial flutter
