Atypical atrial flutter: Exploring the relationship between ibrutinib chemotherapy and atrial myopathy
Bibliographic record
Abstract
Key Teaching Points•The incidence of atrial arrhythmia is 5%–16% in patients taking Bruton’s tyrosine kinase inhibitors, a class of chemotherapeutic agents that is used first line for many hematological malignancies. The main risk factors for developing arrhythmia on treatment are age >65 years, hypertension, prior cardiovascular disease, and a dilated left atrium.•Animal studies have shown ibrutinib leads to off-target kinase inhibition in the myocardium. This leads to increased proinflammatory signaling and impaired cardioprotective mechanisms in the atria, culminating in pathologic remodeling that promotes triggered activity and substrate for reentrant arrhythmias.•A rate control strategy is presently recommended as the first-line treatment option for atrial arrhythmias, with a rhythm control strategy reserved for those who remain symptomatic or develop a rate-related cardiomyopathy. Our case highlights atrial flutter on ibrutinib is amenable to an ablation strategy and should be considered in appropriately selected patients. •The incidence of atrial arrhythmia is 5%–16% in patients taking Bruton’s tyrosine kinase inhibitors, a class of chemotherapeutic agents that is used first line for many hematological malignancies. The main risk factors for developing arrhythmia on treatment are age >65 years, hypertension, prior cardiovascular disease, and a dilated left atrium.•Animal studies have shown ibrutinib leads to off-target kinase inhibition in the myocardium. This leads to increased proinflammatory signaling and impaired cardioprotective mechanisms in the atria, culminating in pathologic remodeling that promotes triggered activity and substrate for reentrant arrhythmias.•A rate control strategy is presently recommended as the first-line treatment option for atrial arrhythmias, with a rhythm control strategy reserved for those who remain symptomatic or develop a rate-related cardiomyopathy. Our case highlights atrial flutter on ibrutinib is amenable to an ablation strategy and should be considered in appropriately selected patients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".