Introduction: Ibrutinib is a selective and irreversible Bruton´s tyrosine kinase inhibitor approved for the treatment of mantle cell lymphoma, chronic lymphocytic leukaemia or Waldestrom´s macroglobulinemia.
Ibrutinib is an arrhythmogenic molecule, although the arrhythmogenic mechanism is not well understood.1 It has been documented that ibrutinib can cause various arrhythmias, including supraventricular tachycardia, atrial fibrillation and ventricular arrhythmias (VA).2 A recent systematic review reported an estimated 100,000 person-year VA incidence rate was 617.3
Methods: We present a patient with a severe presentation of ventricular arrhythmias due to ibrutinib treatment in our centre.
Results: The patient had a previous medical history of combined chronic lymphocytic leukaemia and Waldeström’s macroglobulinemia diagnosed 6 years before. One year before presentation treatment with ibrutinib was initiated. At this moment the patient was taking a 240mg daily dose.
Before drug initiation, a cardiology evaluation with echocardiography was performed, which demonstrated preserved ejection fraction, no valvulopathies or pericardial effusion.
The day of the presentation, the patient’s wife detected the cardiac arrest and began cardiopulmonary resuscitation. Medical staff detected shockable rhythm and advanced resuscitation was performed with 5 shocks, epinephrine and orotracheal intubation with return of spontaneous circulation after 20 minutes.
At the emergency department, EKG showed paroxystic atrial fibrillation and frequent premature polymorphic ventricular beats and non sustained polymorphic ventricular tachycardia. Coronariography and transthoracic echocardiography were performed without significant findings.
Minutes after the presentation the patient suffered another cardiac arrest with pulseless polymorphic ventricular tachycardia (Figure 1) and refractory ventricular fibrillation. ECMO cannulation was performed during CPR but the patient died a few hours later because of vascular complications.
Necropsy and genetic tests were performed, but notable findings were not reported.
Conclusion: Sudden death due to ibrutinib is a fatal and well-described adverse effect. Therefore, a precise and periodic evaluation of patients undergoing ibrutinib´s treatment would be necessary to avoid episodes of sudden death such as the one described.
