Incidence of supraventricular arrhythmias during autologous peripheral blood stem cell transplantation

Abstract

Arrhythmias, especially supraventricular arrhythmias, often complicate the clinical course during autologous hematopoietic cell transplantation (AHCT). We wanted to determine the incidence and risk factors for cardiac arrhythmias during AHCT. The study included 983 patients (median age, 58 years [range, 19 to 77]; 61% male) who underwent AHCT between August 2006 and December 2010 at a single institution and for whom all relevant medical records were available for review. AHCT was done for plasma cell disorders in 58% patients and for lymphoma or leukemia in the remaining. Overall, 92 patients (9.4%) developed a supraventricular tachyarrhythmia at a median of 9 days posttransplantation (range, 0 to 18) and with a median duration of less than 1 day (range, <1 to 17 days). Atrial fibrillation was the most common and seen in 71 patients (7%), followed by atrial flutter and supraventricular tachycardia in 12 (1%) and 8 (1%) patients, respectively. In multivariate analysis, age older than 63 years, presence of premature supraventricular complexes or atrioventricular conduction delay on pretransplantation electrocardiogram, and history of any prior arrhythmia increased the risk of arrhythmia. Development of arrhythmia resulted in longer outpatient follow-up after AHCT, with the median follow-up for those developing an arrhythmia of 22 days compared with 19 days for the rest; P < .001. In conclusion, 9% of patients undergoing ASCT developed supraventricular arrhythmias posttransplantation, and this risk was elevated among older patients, those with a prior history of arrhythmias, and those with pretransplantation electrocardiographic abnormalities.

Keywords: Antiarrhythmics; Arrhythmia; Atrial fibrillation; Autologous hematopoietic cell transplant (AHCT); Electrocardiogram (ECG).

Figure 1. Time to onset of arrhythmia post-transplant

Figure 1 depicts the median time to onset of arrhythmia post transplant (Kaplan Meier estimate). The median estimated time was 9 days (95% CI; 8, 10).

Figure 2. Time to dismissal home after transplant

Figure 2 depicts the median time to dismissal home following transplant (Kaplan Meier estimate). The median time to dismissal after transplant for patients developing an arrhythmia was 22 days as compared to 19 days in those who did not; P < 0.001.

Figure 3. Risk factors predicting development of arrhythmia post transplant

Figure 3 provides the cumulative incidence curves for onset of arrhythmia following transplant. Patients with two or more risk factors, and those with one risk factor present were at 12.7 (95%CI; 6.7, 24) and 6.4 (95% CI; 3.8, 11.3) fold higher risk of developing arrhythmia compared to those with no risk factors.