From the Guidelines
Yes, chronic lymphocytic leukemia (CLL) can cause atrial fibrillation (AFib) and other heart problems, particularly through its treatment with certain medications like ibrutinib, which has been associated with an increased risk of AFib in approximately 6-16% of patients 1.
Mechanisms and Risks
The leukemia itself can directly infiltrate cardiac tissue, causing structural abnormalities that disrupt normal electrical conduction and lead to arrhythmias like AFib. Additionally, CLL often causes anemia, which forces the heart to work harder to deliver oxygen throughout the body, potentially triggering heart rhythm disturbances. The inflammatory state associated with CLL can also damage blood vessels and heart tissue.
- The risk of developing AFib with ibrutinib increases over time, with studies showing that the risk of treatment-emergent AFib was 6.5% after a median exposure time of 13 months 1.
- Furthermore, certain CLL treatments, particularly some chemotherapy agents like anthracyclines, can be cardiotoxic and increase the risk of developing heart problems.
- CLL patients should receive regular cardiac monitoring, especially when starting new treatments, and should promptly report symptoms like palpitations, shortness of breath, chest pain, or unusual fatigue to their healthcare providers, as these could indicate developing cardiac complications.
Management of AFib in CLL Patients
The management of AFib in CLL patients should follow the guidelines for the management of AFib, with consideration of the patient's cancer treatment and potential interactions with antiarrhythmic drugs 1.
- A rhythm-control strategy may be appropriate in some patients, but the effectiveness of antiarrhythmic drugs against drug-induced AFib is derived from case reports, not from prospective studies.
- Rate control can be achieved with AV node–blocking agents, including β-blockers, calcium channel blockers, and/or digoxin, but these agents may increase the risk of bradyarrhythmias induced by some anti-cancer drugs.
- Anticoagulation therapy should be individualized, weighing the risk of thromboembolism against the risk of increased bleeding, and considering the patient's cancer location and extension, anti-cancer drugs used, and other risk-prediction factors 1.
From the Research
Atrial Fibrillation and Heart Problems in CLL Patients
- Atrial fibrillation (AFib) is a known complication in patients with chronic lymphocytic leukemia (CLL), particularly those treated with certain medications like ibrutinib 2, 3, 4.
- The incidence of AFib in CLL patients treated with ibrutinib has been reported to be around 5-9% 2, with a median time to onset of approximately 3.8 months 2.
- Studies have also shown that CLL patients with AFib are at a higher risk of cardiac-related complications, including acute coronary syndrome, acute myocardial infarction, and heart failure 5.
- The development of AFib in CLL patients has been associated with shorter event-free survival and overall survival, independent of other adverse prognostic factors 4.
Risk Factors and Predictions
- Past history of AFib and heart failure have been identified as risk factors for developing treatment-emergent AFib in CLL patients treated with ibrutinib 4.
- Machine learning models have been proposed to identify CLL patients at high risk of AFib on treatment, taking into account treatment type and other risk factors 6.
- Patient comorbidities, rather than CLL-related factors, predict the risk of treatment-emergent AFib in patients treated with ibrutinib 4.
Management and Outcomes
- The management of AFib in CLL patients is crucial, as it can impact hospitalization outcomes and overall survival 5.
- A multidisciplinary approach is recommended for the management of CLL patients with AFib, to improve outcomes and reduce the risk of cardiac-related complications 5.
- Comparative studies have shown that second-generation BTK inhibitors like acalabrutinib may have a more favorable cardiovascular toxicity profile compared to ibrutinib 3.