Bruton’s tyrosine kinase inhibitors (BTKi) have dramatic efficacy against B-cell malignancies, but link with cardiotoxicity, including atrial fibrillation (AF). Burden, severity, and implications of BTKi-related AF are unknown. Leveraging a large-cohort of consecutive B-cell malignancy patients initiated on BTKi from 2009–2020, we identified patients with extended ambulatory rhythm monitoring. The primary outcome was AF burden after BTKi-initiation. Secondary outcomes included ventricular arrhythmia burden and other arrhythmias. Observed incident-AF rates and burden with next-generation BTKi’s were compared to ibrutinib. Multivariable regression defined association between rhythm measures and major adverse cardiac events (MACE), and mortality. There were 98 BTKi-treated patients [38.8% next-generation BTKi’s, 14.3% prior-AF], with 28,224 h of monitoring. Median duration BTKi-use was 34 months. Over mean duration 12 days monitoring, 72.4% developed arrhythmias (16.3% incident-AF, 31.6% other SVTs, 14.3% ventricular tachycardia). 14.3% had high AF-burden. AF-burden was similar between ibrutinib and next-generation BTKi’s. No single antiarrhythmic-therapy prevented BTKi-related AF. However, antiarrhythmic initiation associated with reduction in arrhythmic burden (P = 0.009). In a multivariable model accounting for traditional cardiovascular risk factors, prior-AF associated with increased post-BTKi AF-burden. In follow-up, high AF burden associated with MACE (HR 3.12, P = 0.005) and mortality (HR 2.97, P = 0.007). Among BTKi-treated patients, high AF burden prognosticates future MACE and mortality risk.

Bruton 的酪氨酸激酶抑制剂 (BTKi) 对 B 细胞恶性肿瘤具有显着疗效，但与心脏毒性有关，包括心房颤动 (AF)。 BTKi 相关 AF 的负担、严重程度和影响尚不清楚。利用 2009 年至 2020 年开始接受 BTKi 治疗的大量连续 B 细胞恶性肿瘤患者，我们确定了接受扩展动态心律监测的患者。主要结局是 BTKi 启动后的 AF 负担。次要结局包括室性心律失常负担和其他心律失常。将观察到的下一代 BTKi 的房颤发生率和负担与依鲁替尼进行了比较。多变量回归定义了节律测量与主要不良心脏事件 (MACE) 和死亡率之间的关联。共有 98 名接受 BTKi 治疗的患者 [38.8% 为下一代 BTKi，14.3% 为既往 AF]，监测时间为 28,224 小时。 BTKi 使用时间中位数为 34 个月。在平均 12 天的监测期间，72.4% 的患者出现心律失常（16.3% 发生房颤，31.6% 发生其他 SVT，14.3% 发生室性心动过速）。 14.3% 的人有较高的房颤负担。依鲁替尼和下一代 BTKi 之间的房颤负担相似。没有单一的抗心律失常疗法可以预防 BTKi 相关的 AF。然而，抗心律失常药物的启动与心律失常负荷的减轻相关（ P = 0.009）。在考虑传统心血管危险因素的多变量模型中，既往 AF 与 BTK 后 AF 负担增加相关。在随访中，高房颤负担与 MACE（HR 3.12， P = 0.005）和死亡率（HR 2.97， P = 0.007）相关。在接受 BTKi 治疗的患者中，高 AF 负担预示着未来的 MACE 和死亡风险。