Arrhythmias in the setting of hematopoietic cell transplants

Abstract

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.

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

“…Excessive intravenous fluid administration, as being a part of the treatment protocol, has also been documented as a contributing factor to AF. 18 One study demonstrated that meticulous fluid and weight management during the post-transplant period reduces the incidence of AF. 19 Increased in autonomic nervous system stimulation and adrenergic drive, mediated by cytokines release or intravascular volume alteration, also promote the occurrence of AF during the peri-transplantation period.…”

“…Ultimately, 13 cohort studies consisting of 10 587 HSCT patients were enrolled. 1,3,7,[17][18][19][20][21][22][23][24][25][26] The literature retrieval, review, and selection process are demonstrated in Figure 1. The characteristics of the included studies are presented in Table 1.…”

“…Risk factors for arrhythmias among HSCT patients are shown in Table 2. Several studies have demonstrated well-known established F I G U R E 1 Outline of our search methodology TA B L E 1 Main characteristics of studies included in the meta-analysis of association between hematopoietic stem cell transplant and arrhythmias Hidalgo et al 17 Tonorezos et al 18 Fatema et al 19…”

“…Regarding the mortality rate of HSCT patients who develop arrhythmias, studies conducted by Tonorezos et al and Hidalgo et al showed an increased mortality rate in the arrhythmia group during hospitalization and at the day 30 after transplantation, respectively. 17,18 Patients who develop arrhythmias during hospitalization are associated with a higher hospital mortality HR of 12.17 (95% CI 6.3-23.52) compared to those without arrhythmias. 18 Hidalgo et al demonstrated that this increased risk of mortality in patients with arrhythmias extends 30 days post-HSCT with a mortality HR of 6.584 (95% CI 1.7-26.1).…”

“…17,18 Patients who develop arrhythmias during hospitalization are associated with a higher hospital mortality HR of 12.17 (95% CI 6.3-23.52) compared to those without arrhythmias. 18 Hidalgo et al demonstrated that this increased risk of mortality in patients with arrhythmias extends 30 days post-HSCT with a mortality HR of 6.584 (95% CI 1.7-26.1). 17…”