Practical considerations in the management of patients with atrial fibrillation/flutter and hematologic malignancies

Objective: The purpose of this review is to highlight the nuanced approach for managing drug-drug interactions (DDIs), anticoagulation challenges, and overlapping toxicities in patients with atrial fibrillation (AF) and hematologic malignancies through patient case vignettes. While not all inclusive, these principles may be applicable to additional classes of medications not directly covered in this review. Data Sources: A comprehensive literature search was performed in PubMed to identify clinical trials, retrospective and population-based studies, pharmacokinetic analyses, and registry data evaluating atrial fibrillation management, anticoagulation strategies, and hematologic malignancy treatments. Data Summary: Patients with cancer, especially hematologic malignancies, have an increased risk of AF secondary to aging, overlapping risk factors, and cancer treatments and toxicities. In addition to the increased AF incidence, hematologic malignancies and their treatment increase the complexity of AF management. Mitigating drug-drug interactions (DDIs) between treatments for hematologic malignancies and AF, in particular antiarrhythmic drugs, is increasingly relevant as recent literature supports early rhythm control in patients with new-onset AF. Case-based scenarios highlight the importance of individualized decision making, especially for patients with high-risk hematologic malignancies, curative treatment intent, or significant cardiac comorbidity. Conclusions: Management of AF in patients with hematologic malignancies requires an individualized multidisciplinary approach that carefully balances hematologic malignancy treatment intent, thromboembolic and bleeding risks, DDIs, and patient comorbidities to optimize both cardiovascular and malignancy outcomes.