Atrial fibrillation is the most frequent cardiovascular complication after hematopoietic stem cell transplantation, with an estimated early incidence of 2% to 6%, and is linked to higher mortality.
This review highlights the unique pathophysiology and management challenges of atrial fibrillation in patients post-hematopoietic stem cell transplant, emphasizing the need for individualized care.
Atrial fibrillation (AF) is the most frequent cardiovascular complication after hematopoietic stem cell transplantation (HSCT) and is linked to higher short-term and long-term morbidity and mortality. AF occurring within 30 days post-HSCT reflects an interplay of peri-transplant triggers, conditioning-related myocardial injury, systemic inflammation and infection, rapid fluid shifts with atrial stretch, and electrolyte disturbances. Beyond 30 days, AF is driven by chronic inflammation and graft-vs.-host disease, metabolic dysregulation from immunosuppression, and cumulative cardiotoxic cancer therapies. Management is challenged by thrombocytopenia and drug–drug interactions. In the acute phase, meticulous volume and electrolyte optimization is essential. When AF duration is ≤48 h, preferably ≤12 h, rhythm control (often with amiodarone) may be pursued; otherwise, rate control is generally favored, with beta-blockers preferred. Long-term care should individualize rate vs. rhythm strategies and reassess anticoagulation as counts recover, given potential thromboembolic risk. Prospective studies and HSCT-specific AF risk tools are needed to guide prevention and treatment.
Kawtharany et al. (Wed,) conducted a review in Atrial fibrillation post hematopoietic stem cell transplant. Atrial fibrillation is the most frequent cardiovascular complication after hematopoietic stem cell transplantation, with an estimated early incidence of 2% to 6%, and is linked to higher mortality.