Tyrosine kinase inhibitor–associated ventricular arrhythmias: a case series and review of literature

Background Tyrosine kinase inhibitors (TKIs) have been increasingly used as first-line therapy in hematologic and solid-organ malignancies. Multiple TKIs have been linked with the development of cardiovascular complications, especially atrial arrhythmias, but data on ventricular arrhythmias (VAs) is...

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Published in:Journal of interventional cardiac electrophysiology 2023-08, Vol.66 (5), p.1165-1175
Main Authors: Fazal, Muhammad, Wei, Chen, Chuy, Katherine Lee, Hussain, Kifah, Gomez, Sofia E., BA, Shayena Shah, Pietrasik, Grzegorz, Yadav, Neha, Ghazizadeh, Zaniar, Kapoor, Ridhima, Witteles, Ronald M., Blackmon, Amanda, Wang, Paul J., John, Roy M., Narayan, Sanjiv M., Cheng, Paul, Rhee, June-Wha, Baykaner, Tina
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-Arrhythmia Agents - therapeutic use
Arrhythmia
Arrhythmias, Cardiac - chemically induced
Arrhythmias, Cardiac - drug therapy
Cardiac arrhythmia
Cardiology
Cardiovascular diseases
Chemotherapy
Complications
Death, Sudden, Cardiac - prevention & control
Defibrillators, Implantable - adverse effects
Drug therapy
Enzyme inhibitors
Health risks
Humans
Kinases
Literature reviews
Malignancy
Medicine
Medicine & Public Health
Middle Aged
Patients
Retrospective Studies
Risk factors
Tachycardia
Tachycardia, Ventricular
Tyrosine
Tyrosine Kinase Inhibitors
Ventricle
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Summary:Background Tyrosine kinase inhibitors (TKIs) have been increasingly used as first-line therapy in hematologic and solid-organ malignancies. Multiple TKIs have been linked with the development of cardiovascular complications, especially atrial arrhythmias, but data on ventricular arrhythmias (VAs) is scarce. Methods Herein we describe five detailed cases of VAs related to TKI use in patients with varied baseline cardiovascular risk factors between 2019 and 2022 at three centers. Individual chart review was conducted retrospectively. Results Patient ages ranged from 43 to 83 years. Three patients were on Bruton’s TKI (2 ibrutinib and 1 zanubrutinib) at the time of VAs; other TKIs involved were afatinib and dasatinib. Three patients had a high burden of non-sustained ventricular tachycardia (NSVT) requiring interventions, whereas two patients had sustained VAs. While all patients in our case series had significant improvement in VA burden after TKI cessation, two patients required new long-term antiarrhythmic drug therapy, and one had an implantable defibrillator cardioverter (ICD) placed due to persistent VAs after cessation of TKI therapy. One patient reinitiated TKI therapy after control of arrhythmia was achieved with antiarrhythmic drug therapy. Conclusions Given the expanding long-term use of TKIs among a growing population of cancer patients, it is critical to acknowledge the association of TKIs with cardiovascular complications such as VAs, to characterize those at risk, and deploy preventive and therapeutic measures to avoid such complications and interference with oncologic therapy. Further efforts are warranted to develop monitoring protocols and optimal treatment strategies for TKI-induced VAs.
ISSN:1572-8595
1383-875X
1572-8595
DOI:10.1007/s10840-022-01400-z