Acute weight gain and diastolic dysfunction as a potent risk complex for post stem cell transplant atrial fibrillation

Abstract

The management of atrial fibrillation (AF) following stem cell transplant (SCTX) is often challenging because of the universal presence of profound bone marrow suppression. The incidence of and risk factors for AF/flutter following SCTX are not well known. A total of 395 multiple myeloma (MM) patients consecutively underwent SCTX between 2002 and 2005 at the Mayo Clinic, and 383 of whom, mean age 57 ± 9 years, had no history of evidence of AF/flutter constituted the study population. During 1,002 person-years of follow up, 39 (10%) patients developed first AF/flutter (incidence of 39 per 1,000 person years), and 28 of these (72%) occurred within 21 days of SCTX. In multivariable-adjusted analyses, weight gain of 7% in the 1st week post-SCTX (HR 3.68; P 5 0.0120) and presence of diastolic dysfunction at MM diagnosis (HR 2.294; P 5 0.0082) were independent predictors of AF/flutter. The risk of AF/flutter post-SCTX increased by about ninefold when both factors were present. Compared to age and sex-matched MM patients without SCTX, the risk of AF/flutter differed significantly only over the 1st year after MM diagnosis, during which SCTX was performed for the majority. Beyond the 1st year, there was no significant difference in risk of AF/flutter between the two groups. The data suggested that SCTX was associated with significantly increased risk of first AF/flutter, which typically occurred within the first 21 days of the transplant. Weight gain of 7% was strongly predictive of first AF/flutter, and the risk was augmented by the presence of diastolic dysfunction at baseline. Am. J. Hematol. 84:499-503, 2009. V

Arrhythmias in the setting of hematopoietic cell transplants

“…Patients with a new arrhythmia after transplant had an 8-fold increase in risk of ICU admission, a 9-fold increase in risk for in-hospital death and a 3-fold increase in risk for death within one year of transplant. Notably, this single-center study found a lower prevalence of arrhythmias following transplant than prior reports 20 , 21 , 32 , possibly due to the relative youth of the patients in this analysis.…”

Arrhythmias in the setting of hematopoietic cell transplants

“…Patients with a new arrhythmia after transplant had an 8-fold increase in risk of ICU admission, a 9-fold increase in risk for in-hospital death and a 3-fold increase in risk for death within one year of transplant. Notably, this single-center study found a lower prevalence of arrhythmias following transplant than prior reports 20 , 21 , 32 , possibly due to the relative youth of the patients in this analysis.…”

Arrhythmias in hematopoietic stem cell transplantation: A systematic review and meta‐analysis

“…With respect to the modifiable risk factors, Gertz et al and Fatema et al showed consistent data that significant weight gain defined arbitrarily as more than 7% during the immediate post‐HSCT, about a week, increased the risk of post‐HSCT arrhythmias …”

“…31 articles were additionally excluded from full‐length review as they did not report the arrhythmia incidence or mortality risk/rate associated with arrhythmias in HSCT patients, and 23 articles were excluded because they were not observational studies. Ultimately, 13 cohort studies consisting of 10 587 HSCT patients were enrolled . The literature retrieval, review, and selection process are demonstrated in Figure .…”

“…Several studies have demonstrated well‐known established risk factors classified generally into modifiable and unmodifiable risk factors. For unmodifiable risk factors, the majority are shared with those in the general population at arrhythmia risk including older age, pre‐existing cardiac condition, history of mediastinal radiation, and abnormal renal function …”

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

“…Severe sepsis was associated with 14% of all episodes of new-onset AF occurring in hospitalized adults. Standard demographic risk factors for community-acquired AF such as older age, male sex and white race 15,16 and previously-described AF-associated comorbidities such as heart failure, obesity 15,16 and malignancy, 39–41 were also associated with new-onset AF during severe sepsis. In addition, prevalent stroke was associated with new-onset AF, a finding that suggests some patients with new-onset AF may have had undiagnosed paroxysmal AF.…”

Arrhythmias in the setting of hematopoietic cell transplants

“…Patients with a new arrhythmia after transplant had an 8-fold increase in risk of ICU admission, a 9-fold increase in risk for in-hospital death and a 3-fold increase in risk for death within one year of transplant. Notably, this single-center study found a lower prevalence of arrhythmias following transplant than prior reports 20 , 21 , 32 , possibly due to the relative youth of the patients in this analysis.…”

Arrhythmias in hematopoietic stem cell transplantation: A systematic review and meta‐analysis

“…With respect to the modifiable risk factors, Gertz et al and Fatema et al showed consistent data that significant weight gain defined arbitrarily as more than 7% during the immediate post‐HSCT, about a week, increased the risk of post‐HSCT arrhythmias …”

“…31 articles were additionally excluded from full‐length review as they did not report the arrhythmia incidence or mortality risk/rate associated with arrhythmias in HSCT patients, and 23 articles were excluded because they were not observational studies. Ultimately, 13 cohort studies consisting of 10 587 HSCT patients were enrolled . The literature retrieval, review, and selection process are demonstrated in Figure .…”

“…Several studies have demonstrated well‐known established risk factors classified generally into modifiable and unmodifiable risk factors. For unmodifiable risk factors, the majority are shared with those in the general population at arrhythmia risk including older age, pre‐existing cardiac condition, history of mediastinal radiation, and abnormal renal function …”

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

“…Severe sepsis was associated with 14% of all episodes of new-onset AF occurring in hospitalized adults. Standard demographic risk factors for community-acquired AF such as older age, male sex and white race 15,16 and previously-described AF-associated comorbidities such as heart failure, obesity 15,16 and malignancy, 39–41 were also associated with new-onset AF during severe sepsis. In addition, prevalent stroke was associated with new-onset AF, a finding that suggests some patients with new-onset AF may have had undiagnosed paroxysmal AF.…”

Arrhythmias in the setting of hematopoietic cell transplants

“…Patients with a new arrhythmia after transplant had an 8-fold increase in risk of ICU admission, a 9-fold increase in risk for in-hospital death and a 3-fold increase in risk for death within one year of transplant. Notably, this single-center study found a lower prevalence of arrhythmias following transplant than prior reports 20 , 21 , 32 , possibly due to the relative youth of the patients in this analysis.…”

Arrhythmias in hematopoietic stem cell transplantation: A systematic review and meta‐analysis

“…With respect to the modifiable risk factors, Gertz et al and Fatema et al showed consistent data that significant weight gain defined arbitrarily as more than 7% during the immediate post‐HSCT, about a week, increased the risk of post‐HSCT arrhythmias …”

“…31 articles were additionally excluded from full‐length review as they did not report the arrhythmia incidence or mortality risk/rate associated with arrhythmias in HSCT patients, and 23 articles were excluded because they were not observational studies. Ultimately, 13 cohort studies consisting of 10 587 HSCT patients were enrolled . The literature retrieval, review, and selection process are demonstrated in Figure .…”

“…Several studies have demonstrated well‐known established risk factors classified generally into modifiable and unmodifiable risk factors. For unmodifiable risk factors, the majority are shared with those in the general population at arrhythmia risk including older age, pre‐existing cardiac condition, history of mediastinal radiation, and abnormal renal function …”

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

“…Severe sepsis was associated with 14% of all episodes of new-onset AF occurring in hospitalized adults. Standard demographic risk factors for community-acquired AF such as older age, male sex and white race 15,16 and previously-described AF-associated comorbidities such as heart failure, obesity 15,16 and malignancy, 39–41 were also associated with new-onset AF during severe sepsis. In addition, prevalent stroke was associated with new-onset AF, a finding that suggests some patients with new-onset AF may have had undiagnosed paroxysmal AF.…”