Ibrutinib-associated atrial fibrillation treatment with catheter ablation.
Ibrutinib-associated atrial fibrillation treatment with catheter ablation.
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DOI：
10.1016/j.hrcr.2021.08.003
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发表时间：
2021-11
影响因子：
--
通讯作者：
Baykaner T
中科院分区：
文献类型：
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作者：
Kapoor R;Fazal M;Cheng P;Witteles R;Rhee JW;Baykaner T
酪氨酸激酶抑制剂（TKI）已被广泛用于治疗各种恶性肿瘤，显着提高生存率。这些治疗的使用受到不良反应的限制。伊布替尼是一种布鲁顿酪氨酸激酶（BTK）抑制剂，与约5%-16%患者的房颤（AF）患病率增加相关，尤其是有AF既往史的患者，1并且通常导致相当比例的患者停止治疗。该患者人群的AF管理也面临着独特的挑战。目前的指南建议将心率控制作为主要策略，2，3这可能具有挑战性，因为药物管理受到与癌症治疗的显著药物相互作用以及潜在副作用的限制。此外，该策略中抗凝治疗的必要性受到了因伊鲁替尼抑制胶原诱导的血小板聚集而导致出血风险增加的挑战。4最近的研究证明了导管消融术在维持普通人群窦性心律方面的长期益处。我们介绍了1例伊鲁替尼相关的症状性房颤病例，该病例通过消融治疗成功治疗，并允许患者恢复伊鲁替尼治疗，以充分管理其癌症（图1）。
Tyrosine kinase inhibitors (TKIs) have been widely used to treat various malignancies, dramatically improving survival. The use of these treatments has been limited by adverse effects. Ibrutinib, a Bruton’s tyrosine kinase (BTK) inhibitor, has been associated with increased prevalence of atrial fibrillation (AF) in approximately 5%–16% of patients, especially those with prior history of AF, 1 and often leads to treatment discontinuation in a significant proportion of patients. Management of AF in this patient population also presents a unique challenge. Current guidelines recommend rate control as the primary strategy, 2, 3 which can be challenging, since pharmacological management is limited by significant drug interactions with cancer therapies as well as potential side effects. Additionally, the need for anticoagulation in this strategy is challenged by increased risk of bleeding owing to inhibition of collagen-induced platelet aggregation by ibrutinib. 4 Recent studies document the long-term benefits of catheter ablation in maintaining sinus rhythm in the general population. We present a case of ibrutinib-associated symptomatic AF, which was successfully treated with ablation therapy, and allowed the patient to return to ibrutinib therapy for adequate management of his cancer (Figure 1).