BACKGROUND Ibrutinib is an oral irreversible inhibitor of Bruton's tyrosine kinase, indicated for the treatment of chronic lymphocytic leukaemia. The drug is generally well tolerated; however, not infrequent side effects are reported, with the major two being bleeding and ibrutinib-related atrial fibrillation. Atrial fibrillation pathogenesis in this setting is not completely clear, and no prospective studies have evaluated the impact of previous cardiologic history and baseline characteristics. METHODS We prospectively performed cardiologic assessment in 43 CLL patients before starting ibrutinib therapy. Cardiologic workup included comorbidity collection and electrocardiographic and echocardiographic baseline evaluation. RESULTS After a median observation of 8 months, seven patients developed atrial fibrillation (16.3%). Cases developing atrial fibrillation were all elderly males (p = 0.04), and mostly with a history of previous arterial hypertension (p = 0.009). Atrial fibrillation occurrence also correlated with the presence of one or more pre-existent cardiologic comorbidities (p = 0.03), with a higher atrial fibrillation risk score (calculated with comorbidities and cardiologic risk factor evaluation p < 0.001), and with higher left atrial diameter (p = 0.02) and area (p = 0.03) by echocardiography. The occurrence of atrial fibrillation was managed after an integrated cardio-oncologic evaluation: anticoagulation was started in 4 (57.1%) patients and beta-blockers or amiodarone in 5 (71.4%). One patient underwent electric cardioversion and another patient pacemaker positioning to normalise heart rate in order to continue ibrutinib. CONCLUSION Our data show that echocardiography is a highly informative and reproducible tool that should be included in pre-treatment workup for patients who are candidates for ibrutinib therapy.

中文翻译：

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依鲁替尼治疗的CLL患者房颤的预测因素：一项前瞻性研究。

背景技术依鲁替尼是Bruton酪氨酸激酶的口服不可逆抑制剂，被指定用于治疗慢性淋巴细胞性白血病。该药一般耐受性良好；然而，没有副作用的报道，主要的两个是出血和依鲁替尼相关的心房颤动。在这种情况下，心房颤动的发病机理尚不完全清楚，也没有前瞻性研究评估过以前的心脏病史和基线特征的影响。方法我们在开始进行依鲁替尼治疗之前对43名CLL患者进行了前瞻性心脏评估。心脏检查包括合并症收集以及心电图和超声心动图基线评估。结果在平均观察8个月后，有7例患者发生了房颤（16.3％）。发生心房颤动的病例均为老年男性（p = 0.04），且多数有既往动脉高压病史（p = 0.009）。房颤的发生还与一种或多种先前存在的心脏病合并症相关（p = 0.03），较高的房颤风险评分（通过合并症和心脏病危险因素评估得出的p <0.001），以及较高的左房直径（p = 0.02）和面积（p = 0.03）通过超声心动图检查。经过综合的心脏肿瘤学评估后可以控制房颤的发生：4例（57.1％）患者开始抗凝治疗，5例（71.4％）患者接受β-受体阻滞剂或胺碘酮治疗。一名患者接受了心脏电复律，另一名患者使心脏起搏器定位以使心率正常化，从而继续进行依鲁替尼治疗。