Incidence, Risk factors, prognosis, and electrophysiological mechanisms of atrial arrhythmias after lung transplantation

Kongkiat Chaikriangkrai, Soma Jyothula, Hye Yeon Jhun, Su Min Chang, Edward A. Graviss, Mossaab Shuraih, Tapan G. Rami, Amish S. Dave, Miguel Valderrábano

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Objectives The purpose of this study was to investigate the incidence and timing, risk factors, prognostic significance, and electrophysiological mechanisms of atrial arrhythmia (AA) after lung transplantation. Background Although new-onset AA is common after thoracic surgery and is associated with poorer outcomes, prognostic and mechanistic data are sparse in lung transplant populations. Methods A total of 293 consecutive isolated lung transplant recipients without known AA were reviewed retrospectively. Mean follow-up was 28 ± 17 months. Electrophysiology studies (EPS) were performed in 25 patients with AA. Results The highest incidence of new-onset AA after lung transplantation occurred within 30 days after transplantation (25% of all patients). In multivariable analysis, post-operative AA was associated with double-lung transplantation (odds ratio: 2.79; p = 0.005) and lower mean pulmonary artery pressure (odds ratio: 0.95; p = 0.027). Patients with post-operative AA had longer hospital stays (21 days vs. 12 days; p < 0.001). Post-operative AA was independently associated with late AA (hazard ratio: 13.52; p < 0.001) but not mortality (hazard ratio: 1.55; p = 0.14). On EPS, there were 14 patients with atrial flutter alone and 11 with atrial flutter and fibrillation. Among all EPS patients, 20 (80%) had multiple AA mechanisms, including peritricuspid flutter (48%), perimitral flutter (36%), right atrial incisional re-entry (24%), focal tachycardia from recipient pulmonary vein (PV) antrum (32%), focal PV fibrillation (24%), and left atrial roof flutter (20%). Left atrial mechanisms were present in 80% of EPS patients (20 of 25) and originated from the anastomotic PV antrum. Conclusions Post-operative AA was independently associated with longer length of stay and late AA but not mortality. Pleomorphic PV antral arrhythmogenesis from native PV antrum is the main cause of AA after lung transplantation.

Original languageEnglish (US)
Pages (from-to)296-305
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume1
Issue number4
DOIs
StatePublished - Aug 2015

Keywords

  • atrial arrhythmia
  • atrial fibrillation
  • atrial flutter
  • lung transplant

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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