TABLE 29.

Medical Cancer Therapy Associated With Increased Risk of AF (>1%)

Cancer Therapy	Frequency Reported in Clinical Trials and Observational Studies		Comments
	Common: Incidence 1%-10%	Frequent: >10%
Anthracyclines Doxorubicin, epirubicin, idarubicin, mitoxantrone		X	AF may be a secondary result of anthracycline cardiotoxicity; studies in different populations demonstrate variable risk of AF
Antimetabolites
Clofarabine combined with cytarabine		X
5FU	X
Cepecitabine	X
Gemcitabine	X
Alkylating agents Cyclophosphamide	X		*Stem cell transplantation is associated with an increased risk of AF,28,29 and the risk may be higher with melphalan-associated regimens.
Melphalan + stem cell transplantation		X*
Immunomodulatory drugs Lenalidomide	X		Given rates reported from patients with multiple myeloma, AF due to underlying cardiac AL amyloid may contribute
Interleukin-2	X
TKIs Ibrutinib (BTKi)	X†	X†	†Reported AF rates with ibrutinib have varied across trials (4%-18%),6,30 partly related to varying duration of follow-up and patient factors. Second-generation BTKis have more selective BTK activity and are associated with a lower incidence of AF than ibrutinib.31 Based on FDA adverse event reporting system4
Acalbrutinib (second-generation BTKi)	X
Zanubrutinib (second-generation BTKi)	X
Ponatinib (BCR-ABL TKI) and other TKIs (eg, trametinib, osimertinib, nilotinib, ribociclib)	X
VEGF inhibitor
Sorafenib in combination with 5FU	X
BRAF inhibitor
Vemurafenib	X
CAR T-cell therapy
Tisagenlecleucel	X
Axicabtagene ciloleucel	X
Monoclonal antibodies
Rituximab	X

Table developed by 2023 Atrial Fibrillation Guideline Writing Committee. Data extracted from Buza et al³² and Fradley et al.³³

AF indicates atrial fibrillation; BTKi, Bruton’s kinase inhibitor; CAR, chimeric antigen receptor; FDA, US Food and Drug Administration; 5FU, 5 fluorouracil; and TKI, tyrosine kinase inhibitor.