Management of cardiovascular complications of bruton tyrosine kinase inhibitors.

If AF rate control is not possible pharmacologically, then atrioventricular node (AVN) ablation and cardiac resynchronisation therapy (CRT) pacemaker implantation may be considered for symptomatic fast AF when CLL-related prognosis is more than one year.66,67 Recent studies have shown that the leading cause of death for AF patients already treated with appropriate anticoagulation is heart failure. Second, there are multiple drug interactions between ibrutinib and antiarrhythmic agents used for rate and rhythm control (amiodarone, digoxin, verapamil and diltiazem) via CYP3A4 hepatic metabolism.63-65 Atrial fibrillation ablation targeting the pulmonary veins is not recommended as it rarely offers long term AF-free survival. Keywords: ibrutinib; bruton tyrosine kinase inhibitor; atrial fibrillation; hypertension; sudden cardiac death; cardiovascular complication EN ibrutinib bruton tyrosine kinase inhibitor atrial fibrillation hypertension sudden cardiac death cardiovascular complication 70 78 9 12/27/21 20220101 NES 220101 Methodology This Good Practice Paper was compiled according to the British Society for Haematology (BSH) process at BSH Guidelines Development Process (PDF). GRAPH Footnotes 1 A recent alert from an unpublished clinical trial (FLAIR: a phase III, randomised controlled trial comparing the use of ibrutinib and rituximab [IR] versus FCR versus ibrutinib and venetoclax in treatment naïve CLL patients) reported that patients in the ibrutinib and rituximab (IR) arm have an elevated risk of sudden cardiac death if they were on ACE inhibitor treatment at study entry versus patients not on ACE inhibitors at study entry. [Extracted from the article]