Abstract 4146553: Efficacy and Safety of Catheter Ablation in Patients with Hematologic Malignancies

Introduction: Patients with cancer have an increased risk for arrhythmias. Patients with hematologic malignancies face unique challenges in medical management of arrhythmias including increased bleeding risk limiting the use of anticoagulation therapies, increased clotting risk due to malignancy leading to a higher risk of stroke in the setting of atrial arrhythmias and lastly drug-drug interactions with chemotherapy agents limiting medical treatment options of arrhythmias. Safety and efficacy of catheter ablation in patients with hematologic malignancies have not previously been assessed. Hypothesis: We hypothesized that catheter ablation in patients with hematologic malignancies is safe, with reasonable acute and long term outcomes. Methods: We performed a retrospective analysis of consecutive patients with hematologic malignancies who underwent catheter ablation of AF, documenting procedural safety, acute and long term outcomes. Results: We identified 33 patients (n=21 with chronic lymphocytic leukemia, n=3 with chronic myeloid leukemia, n=4 with Waldenstrom's Macroglobulinemia, n=5 other) who underwent catheter ablation for arrhythmias after oncologic diagnosis between 2013-2024. Mean left-ventricular systolic ejection fraction was 57 ± 10%. Mean indexed left-atrial volume was 43±17 ml/m2. 11 (33%) patients underwent AF ablation alone, and 12 (36%) patients underwent AF and AFL ablation. 7 (21%) patients underwent typical AFL ablation with a cavotricuspid isthmus ablation alone. 5 (15%) patients underwent other SVT ablations (AVNRT, AT). 1 (3%) patient had pericardial effusion requiring pericardiocentesis. Over a mean follow up of 26 ± 22 months from catheter ablation, 12 (36%) patients had their oncologic therapy held due to arrhythmias. Out of the 23 patients that underwent AF ablation, 10 (43%) had AF recurrence at 2-year follow up. Of the patients who had AFL ablation, 2 (11%) had recurrent AFL at 2 year follow up. No recurrences were noted in the SVT ablation group. 17 (51%) patients were treated with tyrosine kinase inhibitors (TKI) which have been associated with incident AF, and 13 (39%) were maintained on TKIs at the time of ablation. Conclusion: Catheter ablation can be a safe and effective strategy for management of arrhythmias in patients with hematologic malignancies, with outcomes similar to the general population.