Prior studies report 9–27% of persons receiving a hematopoietic cell transplant develop arrhythmias, but the effect on outcomes is largely unknown. We reviewed data from 1177 consecutive patients {greater than or equal to}40 years old receiving a hematopoietic cell transplant at one center during 1999–2009. Transplant indication was predominately leukemia, lymphoma and multiple myeloma. Overall, 104 patients were found to have clinically significant arrhythmia: 43 prior to and 61 following transplant. Post-transplant arrhythmias were most frequently atrial fibrillation(N=30), atrial flutter(N=7) and supraventricular tachycardia(N=11). Subjects with an arrhythmia post-transplant were more likely to have longer median hospital stays (32 days vs 23, P=<.001,) a greater probability of an ICU admission (52% vs 7%; P<.001), more inhospital deaths (28% vs 3%, P<0.001), and more deaths within one year of transplant (41% vs 15%; P<0.001) than patients without arrhythmia at any time. In a multivariate model including age at transplant, diagnosis, history of pre-transplant arrhythmia, and transplant-related variables, post-transplant arrhythmia was associated with a greater risk of death within a year of transplant (OR 3.5, 95% CI: 2.1, 5.9; P < 0.001). Our data suggest arrhythmias after transplants are associated with significant morbidity and mortality. A prospective study of arrhythmia in the transplant setting is warranted.

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The management of perioperative cardiovascular risk in patients with rheumatoid arthritis (RA) is challenging due to the independent contribution to risk by high grade inflammatory mechanisms and the underestimation of risk by traditional cardiac risk factors alone.

Table. Patient demographics and out of pocket costs for first 3 months after allogeneic HCT Patient characteristics N 5 25 Median patient age (range) 44 (24-71) years Non-Hispanic White race 24 (96%) Residence >50 miles from HCT center 12 (48%) Needed temporary move to HCT center 12 (48%) Median annual pre-tax income at study enrollment (range) $65,000 (18,500-150,000) Household income reduced due to illness 20 (80%) Diagnosis Acute leukemia/MDS 22 (88%) Other 3 (12%) Donor type Related 10 (40%) Unrelated/UCB 15 (60%) Conditioning intensity Myeloablative 12 (48%) Non-myeloablative/RIC 13 (52%) Out-of-pocket costs N 5 15 Median costs (inter-quartile range)