Ibrutinib-related atrial fibrillation common, predicted by left atrial volume index
Ibrutinib-related atrial fibrillation (IRAF) occurs more frequently than previously reported, with the left atrial volume index (LAVI) independently predicting such events, a study has found.
Researchers performed standardized monitoring in 53 consecutive patients (median age, 70 years; 74 percent male; median body mass index, 25 kg/m2) prior to and during ibrutinib therapy.
IRAF occurred in 14 patients (26 percent) after a median of 13 months, resulting in an incidence rate of 25.0 per 100 person-years. The cumulative incidence rate of IRAF was 21 percent at 6 months, 23 percent at 12 months and 38 percent at 24 months. The majority of events occurred in asymptomatic patients within a median time of 5.5 months.
Of note, the incidence of IRAF at 2 years was 15 times higher than the risk of atrial fibrillation observed in both the general population and chronic lymphocytic leukaemia patients not exposed to ibrutinib (p<0.0001).
The risk of developing IRAF was significantly higher in the presence of LAVI ≥40 mL/m2 at treatment initiation. None of the patients on ibrutinib had major bleeding events, although the majority of patients with IRAF received anticoagulants.
The present data highlight the importance of performing standardized and close monitoring of asymptomatic patients in the first few months following initiation of ibrutinib, the researchers said. Furthermore, LAVI measurement may help identify patients at high risk and that anticoagulants could be considered in the absence of significant bleeding risk.