Atrial Fibrillation Across the Hematopoietic Cell Transplantation Continuum: A Systematic Scoping Evidence Map

Purpose of Review Atrial fibrillation and atrial flutter (AF/AFL) are clinically relevant complications across the haematopoietic cell transplantation (HCT) continuum, but evidence supporting phase-specific management and transitions of care remains fragmented. This review aimed to map direct HCT-AF evidence, broader HCT cardiovascular evidence, and relevant guidance; identify major evidence-to-care gaps; and define an evidence-informed framework for AF/AFL management across the HCT continuum. Recent Findings We conducted a systematic scoping evidence map of PubMed/MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials, supplemented by a predefined closed hand-search of guidance sources. Twenty-seven clinical reports and 15 guidance documents were retained, yielding 42 evidence sources. Direct evidence was concentrated on AF/AFL incidence, timing, predictors, recurrence, and prognosis, whereas evidence for treatment selection, rhythm-surveillance strategies, anticoagulation during thrombocytopenia, and survivorship follow-up remained limited and frequently dependent on extrapolated guidance. The evidence map informed a phase-specific care framework spanning pre-HCT risk assessment, risk-adapted rhythm surveillance, structured acute AF/AFL assessment, dynamic anticoagulation reassessment, medication-safety review, and accountable discharge and survivorship follow-up. Summary AF/AFL after HCT should be viewed as a longitudinal care challenge rather than an isolated inpatient arrhythmic event. The proposed phase-specific quality-of-care processes are hypothesis-generating and require prospective evaluation for feasibility, reproducibility, implementation, and association with clinical outcomes. Graphical Abstract Atrial fibrillation across the HCT continuum. Evidence-informed, phase-specific framework integrating AF/AFL risk assessment, risk-adapted rhythm surveillance, acute management, dynamic anticoagulation reassessment, medication-safety review, survivorship care, and key evidence-to-care gaps across the HCT continuum. The lower panel highlights system-level enablers for integrating AF-HCT care, including multidisciplinary care, structured processes, data collection, education, care-transition communication, and continuous quality assessment. The proposed framework and candidate quality-of-care processes are hypothesis-generating and require prospective validation. AF, atrial fibrillation; AFL, atrial flutter; BNP, B-type natriuretic peptide; BTK, Bruton tyrosine kinase; CV, cardiovascular; ECG, electrocardiogram; HCT, haematopoietic cell transplantation; QTc, corrected QT interval