Atrial Fibrillation Following Autologous Stem Cell Transplantation in Multiple Myeloma: Incidence, Predictors, and Prognostic Impact (JACC: CardioOncology State-of-the-Art Review February 2026))-Article: Atrial Fibrillation Following Autologous Stem Cell Transplantation in Multiple Myeloma: Incidence, Predictors, and Prognostic Impact

Article: Atrial Fibrillation Following Autologous Stem Cell Transplantation in Multiple Myeloma: Incidence, Predictors, and Prognostic Impact

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This retrospective study analyzed 801 multiple myeloma (MM) patients undergoing autologous stem cell transplantation (ASCT) between 2016-2022, to assess the incidence, risk factors, and prognostic impact of atrial fibrillation (AF) post-transplant. Patients with baseline AF were excluded. Over a median follow-up of 36.2 months, 8.7% developed AF after ASCT, with cumulative incidences of 5.5% at 90 days and 9.0% at 3 years; median AF onset was 13 days post-transplant.<br /><br />Multivariable analysis identified independent predictors for post-ASCT AF as age ≥65 years (HR 1.88), prior paroxysmal AF (HR 6.19), and obesity (HR 2.00). Pretransplantation cardiac markers like left atrial volume index >34 mL/m² and QTc interval ≥480 ms showed associations but lost significance after adjustment, except QTc prolongation predicted AF in patients without prior AF.<br /><br />AF occurrence post-transplant was strongly linked to poor outcomes, conferring a 5-fold increased risk of all-cause mortality and a 4.5-fold higher risk of non-relapse mortality (NRM), independent of other factors. Early AF events (within 30 days) and later events appeared in different clinical contexts, often associated with systemic inflammation or infection. A sensitivity analysis excluding patients with prior AF confirmed similar predictors and adverse survival impacts.<br /><br />This study highlights AF as a frequent and serious complication in MM patients receiving ASCT, associated with older age, prior arrhythmia history, and obesity. The findings underscore the importance of comprehensive cardiovascular evaluation including echocardiography and ECG before transplantation, along with vigilant post-transplant monitoring to identify high-risk patients. The strong mortality association suggests AF is a marker of vulnerability beyond disease relapse.<br /><br />Limitations include retrospective single-center design and variable post-discharge rhythm monitoring, potentially underestimating AF incidence. Future research should validate these findings externally and explore whether early rhythm control strategies can improve outcomes in this high-risk group.<br /><br />In conclusion, AF after ASCT in MM patients signifies elevated risk for mortality and should prompt targeted cardiovascular risk assessment and monitoring protocols to optimize management and survival.

Keywords

multiple myeloma

autologous stem cell transplantation

atrial fibrillation

post-transplant complications

risk factors

mortality risk

cardiovascular evaluation

echocardiography

QTc prolongation

obesity