![]() 1–4 Notably, AFIB is the most common cause of ibrutinib discontinuation in clinical practice, underscoring the need to decrease the risk of AFIB and premature, unnecessary ibrutinib discontinuation. Randomized data from three large clinical trials have demonstrated an association between ibrutinib treatment and the development of atrial fibrillation (AFIB) in chronic lymphocytic leukemia (CLL) patients with an incidence of 11% in long-term follow-up. ![]() LAA identified by EKG is a moderately specific and sensitive finding that can identify patients at increased risk for this toxicity. Area under the ROC curve for the model was estimated to be 75%. Age, baseline HTN, CAD, diabetes, age and sex were not significant predictors. Left atrial enlargement was identified as a significant predictor of development of atrial fibrillation (OR 9.1, 95% CI 2.2–37.3, p=0.02). 20 (11.3%) of patients developed atrial fibrillation. 44 patients met inclusion criteria (20 cases, 24 controls). 183 consecutively CLL patients treated with ibrutinib were identified. Risk factors for atrial fibrillation include advanced age, hypertension (HTN), mitral valve disease (MVD), left atrial remodeling, coronary artery disease (CAD) and risk factors for cardiovascular dysfunction We conducted a retrospective case control study using the presence of left atrial abnormality identified on pre-ibrutinib EKGs, defined as either (1) Lead II-bifed p wave, with 40 mcsec between peaks for ≥ 2.5 mm wide ≥ 100 msec in duration, (2) Lead V1-biphasic P wave with terminal portion ≥ 40 msec in duration or terminal portion ≥ 1 mm deep or (3) PR interval ≥ 200 msec (intra-atrial conduction delay) as a predictor for development of atrial fibrillation. ![]() This is a common cause of ibrutinib discontinuation. Results from several recent studies in chronic lymphocytic leukemia (CLL) have demonstrated an association between ibrutinib exposure and the development of atrial fibrillation, estimated incidence of 11% with long-term follow up. ![]()
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