Background: Atrial fibrillation (AF) is a common and clinically significant complication in cancer patients, but data on its incidence and impact among multiple myeloma (MM) patients undergoing autologous stem cell transplantation (ASCT) remain limited.
Objectives: To characterize the incidence, predictors, and prognostic implications of AF following ASCT in MM patients.
Methods: We retrospectively analyzed 801 MM patients who underwent ASCT between 2016 and 2022. Pre-transplant evaluation included ECG and echocardiography within 180 days of conditioning. Patients with AF at baseline were excluded. Post-transplant AF was defined as ECG-confirmed AF occurring after stem cell infusion.
Results: Over a median follow-up of 36.2 months, 70 patients (8.7%) developed post-transplant AF. The cumulative incidence was 5.5% at 90 days and 9.0% at 3 years, with a median onset of 13 days. Independent predictors included age >65 years (HR 1.88; 95% CI 1.16–3.07), prior paroxysmal AF (HR 6.19; 95% CI 3.63–10.5), and obesity (HR 2.00; 95% CI 1.10–3.63). Left atrial volume index >34 mL/m² (HR 1.67; 95% CI 0.99–2.80) and QTc >480 ms (HR 1.69; 95% CI 0.91–3.12) were associated with AF but not statistically significant after adjustment. Among patients without prior AF, QTc >480 ms remained a significant predictor. In multivariable analysis, post-transplant AF conferred a five-fold higher risk of all-cause mortality and a 4.5-fold higher risk of non-relapse mortality.
Conclusion: AF is a frequent and high-risk complication among MM patients undergoing ASCT. Routinely available clinical factors enable risk stratification, underscoring the importance of cardiovascular evaluation and vigilant post-transplant monitoring in this vulnerable population.
JACC CardioOncology Editor-in-Chief and CME Editor
Bonnie Ky, MD, MSCE, FACC
Authors
Jennifer Liu, MD
Important Dates
Date of Release: February 17, 2026
Term of Approval/Date of CME/MOC Expiration: February 16, 2027