Arrhythmias in hematopoietic stem cell transplantation: A systematic review and meta‐analysis

Abstract

Background: There are controversial data regarding the relationship between hematopoietic stem cell transplantation and arrhythmias. This meta-analysis was performed to evaluate the incidence of arrhythmias in patients following hematopoietic stem cell transplantation (HSCT). Methods: A literature search was conducted utilizing MEDLINE, EMBASE, andCochrane Databases from inception through April 2019. Pooled incidence with 95% confidence interval (CI) were calculated using random-effects meta-analysis. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019131833). Results:Thirteen studies consisting of 10,587 patients undergoing HSCT were enrolled in this systematic review. Overall, the pooled estimated incidence of all types of arrhythmias following HSCT was 7.2% (95% CI: 4.9%-10.5%). With respect to the most common type of arrhythmia, the pooled estimated incidence of atrial fibrillation/atrial flutter (AF/AFL) within 30 days following HSCT was 4.2% (95% CI:1.7%-9.6%). Egger's regression test demonstrated no significant publication bias in this meta-analysis of post-HSCT arrhythmia incidence. Conclusion:The overall estimated incidence of arrhythmias following HSCT was 7.2%. Future large scale studies are needed to further elucidate the significance and clinical impact of arrhythmias in post-HSCT patients. K E Y W O R D Satrial fibrillation, bone marrow transplantation, meta-analysis, stem cell transplantation, supraventricular tachycardia | 565 CHIENGTHONG ET al.

Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

“…To date, studies examining AF after HCT have been limited to patients undergoing autologous HCT, [32][33][34][35][36][37][38] representing an older population with greater comorbidities and a higher proportion of pre-HCT cardiotoxic (eg, chest radiation and anthracyclines) exposures, compared with patients undergoing allogeneic HCT. To our knowledge, our study is the first to describe the incidence and risk factors for AF in a contemporary cohort of allogeneic patients, allowing us to capture evolving HCT practices (eg, expanding donor stemcell source, use of nonmyeloablative conditioning, increasingly older age at HCT, and expanded indications for HCT).…”

Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history

“…[ 21 ] A recent meta-analysis revealed that the estimated incidence of all types of arrhythmia following HCT was 7.20% (95% CI: 4.90–10.50), and the most common type was AF/AFL, with an estimated incidence of 4.20% (95% CI: 1.70–9.60). [ 22 ] In our study, the most common post-CCVD were also HF and arrhythmia (6.02% and 5.26%, respectively). Late post-CCVD was reported to be associated with chemotherapy toxicity, CVRFs, chronic graft- vs .-host disease, and long-term physical inactivity.…”

“…The incidence of early fatal cardiotoxicity during the first 100 days post-transplant was reported to be 0.90% to 10.00%, of which the most common events were HF and arrhythmia [21] . A recent meta-analysis revealed that the estimated incidence of all types of arrhythmia following HCT was 7.20% (95% CI: 4.90–10.50), and the most common type was AF/AFL, with an estimated incidence of 4.20% (95% CI: 1.70–9.60) [22] . In our study, the most common post-CCVD were also HF and arrhythmia (6.02% and 5.26%, respectively).…”

“…There was no difference in the median days of neutrophil (14 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] vs. 12 [9-21] days, P = 0.269) and platelet (14 vs. 14 days, P = 0.395) engraftment between the pre-CCVD group and the control group. In the multivariable analysis, rapid neutrophil recovery was associated with a greater number of infused CD34 + cells (P = 0.016) and disease status in remission (P = 0.002).…”

Artificial intelligence opportunities in cardio-oncology: Overview with spotlight on electrocardiography

“…Cardiovascular complications have been reported in this setting primarily as a result of cytokine release syndrome and complications [ 64 ]. The most common malignancy treated with autologous stem cell transplantation is multiple myeloma [ 65 ], which associates with cardiomyopathy and poor outcomes [ 55 , 66 – 69 ].…”