scholarly journals Ibrutinib associated cardiovascular events in a patient wearing an implanted loop recorder

2021 ◽  
Vol 13 (1) ◽  
pp. e2021044
Author(s):  
Daniel Rivera ◽  
Koichi Takahashi ◽  
Jean-Benard Durand ◽  
Alessandra Ferrajoli
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Lymphocytic Leukemia ◽  
Cardiac Arrhythmias ◽  
Cardiovascular Events ◽  
Ventricular Arrhythmias ◽  
Effective Therapy ◽  
Lymphocytic Leukemia ◽  
Loop Recorder

Ibrutinib is a well-tolerated and effective therapy used for the treatment of chronic lymphocytic leukemia (CLL). Its use has been associated with cardiovascular events such as atrial fibrillation (Afib), hypertension, and ventricular arrhythmias. Implanted loop recorders are a useful tool in guiding the management of patients with cardiac arrhythmias.

The impact of atrial fibrillation on hospitalization outcomes for patients with chronic lymphocytic leukemia: A large database analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19508-e19508
Author(s):  
Mohammad Ammad Ud Din ◽  
Samarthkumar Thakkar ◽  
Harsh P. Patel ◽  
Syed Ather Hussain ◽  
Aneeqa Zafar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Chronic Lymphocytic Leukemia ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Lymphocytic Leukemia ◽  
Total Cost ◽  
Patient Admissions ◽  
All Cause Mortality

e19508 Background: With the increased use of novel agents like Bruton tyrosine kinase inhibitors (BTKi) for the treatment of chronic lymphocytic leukemia (CLL), the incidence of atrial fibrillation (AF) is on the rise in these patients. However, the excess burden added by AF to the morbidity and mortality of CLL patients is unclear. Methods: Using the appropriate ICD-9 and ICD-10 codes, the National Inpatient Sample (NIS) database was accessed to gather data of hospitalized CLL patients with AF from 2008 to 2019. Propensity-score matching (PSM) and logistic regression model were performed to control for baseline patient factors like age, sex, income, and the relevant co-morbidities to match 7265 CLL patient admissions with AF and 7265 CLL patient admissions without AF. The primary outcome was all-cause mortality (ACM), while secondary outcomes included stroke, acute heart failure (AHF), and total cost of hospital stay. Results: The mean age of the cohorts was 82 years. Females made up 44% of both groups. The AF group had similar prevalence of systemic hypertension (62.38% vs 62.10%; p= 0.73), diabetes mellitus (5.09% vs 5.43%; p= 0.35), congestive heart failure (5.57% vs 5.36%; p= 0.58), valvular heart disease (1.17% vs 1.44%; p= 0.14), and pulmonary hypertension (0.21% vs 0.14%; p= 0.31) compared to the group without AF. PSM revealed CLL patients with AF had a higher rate of ACM (6.06% vs 4.47%; p= <0.0001), AHF (7.50% vs 3.85%; p= <0.001), and stroke (3.09% vs 1.65%; p= <0.0001). Admission in the AF group also had a higher median total cost of hospital stay ($9097 vs $7646). A logistic regression model was done to adjust for confounders which revealed similar results for the AF group with increased adjusted odd’s ratio (aOR) of ACM (aOR:1.39, 95% confidence interval (CI): 1.19-1.61; p= <0.001), AHF (aOR: 2.16, 95% CI: 1.85-2.52; p= <0.001), and stroke (aOR:1.94, 95% CI: 1.54-2.44; P= <0.001) (Table). Conclusions: Our data suggest that hospitalized CLL patients with AF are at a significantly increased risk of all-cause mortality, AHF, and stroke. Several limitations like the inability to establish the temporal relationship between CLL and AF and the lack of data regarding medications of individual patients are important to keep in mind while interpreting the results.[Table: see text]

scholarly journals Rates of Cardiac Rhythm Abnormalities in Patients with CKD and Diabetes

2019 ◽  
Vol 14 (4) ◽  
pp. 549-556 ◽  
Author(s):  
Nazem Akoum ◽  
Leila R. Zelnick ◽  
Ian H. de Boer ◽  
Irl B. Hirsch ◽  
Dace Trence ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Arrhythmias ◽  
Ventricular Arrhythmias ◽  
Cardiac Rhythm ◽  
Cardiac Monitoring ◽  
Premature Ventricular Contractions ◽  
Mortality And Morbidity ◽  
Conduction Abnormalities ◽  
Patients With Diabetes ◽  
New Diagnosis

Background and objectivesCardiac arrhythmias increase mortality and morbidity in CKD. We evaluated the rates of subclinical arrhythmias in a population with type 2 diabetes and patients with moderate to severe CKD who were not on dialysis.Design, setting, participants & measurementsThis is a prospective observational study, using continuous ambulatory cardiac monitors to determine the rate of atrial and ventricular arrhythmias, as well as conduction abnormalities in this group.ResultsA total of 38 patients (34% women), with mean eGFR of 38±13 ml/min per 1.73 m2, underwent ambulatory cardiac monitoring for 11.2±3.9 days. The overall mean rate of any cardiac arrhythmia was 88.8 (95% confidence interval [95% CI], 27.1 to 184.6) episodes per person-year (PY). A history of cardiovascular disease was associated with a higher rate of detected arrhythmia (rate ratio, 5.87; 95% CI, 1.37 to 25.21; P<0.001). The most common arrhythmia was atrial fibrillation, which was observed in two participants with known atrial fibrillation and was a new diagnosis in four patients (11%), none of whom experienced symptoms. Overall, atrial fibrillation episodes occurred at a rate of 37.6 (95% CI, 2.4 to 112.3) per PY. Conduction abnormalities were found in eight patients (21%), a rate of 26.5 (95% CI, 4.2 to 65.5) per PY. Rates of ventricular arrhythmias were low (14.5 per PY; 95% CI, 4.3 to 32.0) and driven by premature ventricular contractions.ConclusionsCardiac rhythm abnormalities are common in patients with diabetes with moderate to severe CKD not requiring dialysis. Rates of atrial fibrillation are high and episodes are asymptomatic. Future studies are needed to determine the role of screening and upstream therapy of cardiac arrhythmias in this group.

CLO19-024: Risk of Atrial Fibrillation and Pulmonary Toxicities in Patients With Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma Treated With Ibrutinib

2019 ◽  
Vol 17 (3.5) ◽  
pp. CLO19-024
Author(s):  
Nimesh Adhikari ◽  
Myo H. Zaw ◽  
Sriman Swarup ◽  
Anita Sultan ◽  
Upama Sharma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Relative Risk ◽  
Side Effects ◽  
Chronic Lymphocytic Leukemia ◽  
B Cell ◽  
Respiratory Infections ◽  
Meta Analysis ◽  
Lymphocytic Leukemia ◽  
Phase Iii ◽  
Small Lymphocytic Lymphoma

Background: Bruton’s tyrosine kinase (BTK), a kinase downstream of the B-cell receptor, involves in the B cell survival and proliferation and has become an attractive therapeutic target. Ibrutinib is an oral potent, covalent inhibitor of BTK and hence employed in many hematologic malignancies. We performed a systematic review and pooled analysis of randomized controlled trials (RCTs) to determine the risk of atrial fibrillation (AF) and pulmonary toxicities among patients treated with ibrutinib. Methods: We performed a comprehensive literature search using MEDLINE, EMBASE databases, and meeting abstracts through September 2018. Phase 3 RCTs that mention AF and pulmonary toxicities as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio with 95% CI. Random effects model was applied. Results: 4 phase III RCTs with a total of 1,383 patients with chronic lymphocytic leukemia or small lymphocytic lymphoma were eligible. Studies comparing Ibrutinib (I) vs ofatumumab, I vs chlorambucil, I+ bendamustine (B)+ rituximab (R) vs placebo + B+ R, and I vs R were included in the analysis. The AF incidence was 41 (5.686%) in the ibrutinib group vs 8 (1.208%) in the control arm. The relative risk (RR) for AF was statistically significant at 3.825 (95% CI: 1.848–7.917; P<.0001) and RD was 0.041 (95% CI: 0.023–0.059; P<.0001). The RR of all-grade side effects was as follows: cough, 1.133 (95% CI: 0.724–1.773; P=.584); edema, 1.375 (95% CI: 0.943–2.006; P=.098); pneumonia, 1.227 (95% CI: 0.884–1.703; P=.221); and upper respiratory infections (URI), 1.075 (95% CI: 0.809–1.429; P=.616). The RR of high-grade side effects was as follows: cough, 0.373 (95% CI: 0.063–2.209; P=.277); edema, 1.232 (95% CI: 0.199–7.649; P=.822); pneumonia, 1.277 (95% CI: 0.847–1.926; P=.243); and URI, 1.555 (95% CI: 0.239–10.127; P=.644). Conclusion: Our meta-analysis demonstrated that patients on ibrutinib noted a significant increase in the risk of atrial fibrillation with a relative risk of 3.825. However, the risk of pulmonary toxicities was not statistically increased in the ibrutinib group.

Dabigatran in ibrutinib-treated patients with atrial fibrillation and chronic lymphocytic leukemia

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Rita Carlotta Santoro ◽  
Mariapia Falbo ◽  
Luciano Levato ◽  
Piergiorgio Iannaccaro ◽  
Simona Prejanò
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia

Cardiac arrhythmias resulting from experimental head injury

1976 ◽  
Vol 45 (6) ◽  
pp. 609-616 ◽  
Author(s):  
Delbert E. Evans ◽  
William A. Alter ◽  
Stanley A. Shatsky ◽  
E. Neal Gunby
Keyword(s):  
Blood Pressure ◽  
Head Injury ◽  
Cardiac Arrhythmias ◽  
Cardiovascular Events ◽  
Ventricular Arrhythmias ◽  
Adrenergic Blockade ◽  
Content Type ◽  
Arterial Blood ◽  
Before And After ◽  
Fine Print

✓ The cardiovascular events resulting from experimental head injury were studied to determine the incidence of cardiac arrhythmias and to define the autonomic mechanisms responsible for these changes. Electrocardiograms and arterial blood pressure were recorded in anesthetized monkeys before and after the animals were subjected to temporoparietal head impact. Cardiac arrhythmias and hypotension occurred immediately following impact in every animal studied. Various atrioventricular nodal and ventricular arrhythmias were seen. Cholinergic blockade was found to prevent arrhythmias induced by head injury whereas adrenergic blockade was found to be ineffective.

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