Atrial Fibrillation After Pulmonary Transplantation: Incidence, Impact on Mortality, Treatment Effectiveness, and Risk Factors

Dec 23, 2011
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Authors:
Henri C, Giraldeau G, Dorais M, et al.
Citation:
Circ Arrhythm Electrophysiol 2011;Dec 7:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

What is the clinical impact of atrial fibrillation (AF) after lung transplantation?

Methods:

This was a retrospective study of 224 lung transplant recipients (mean age 47 years, bilateral transplant in 56%). There was a history of hypertension in 17% of patients, coronary artery disease in 5.4%, and AF in 1.3%. Episodes of AF >30 seconds were identified by postoperative telemetric monitoring.

Results:

Postoperative AF occurred in 29% of patients at a mean of 5 days, and lasted a mean of 3 days. The mean length of stay was significantly longer among patients with AF (52 days) than among those without AF (31 days), as was in-hospital mortality (18.5% vs. 6.3%, respectively). By multivariate analysis, AF was not independently associated with mortality or postoperative stroke. The strongest mortality risk factors were bronchial dehiscence and postoperative vasopressor usage. The most frequent AF therapy was intravenous amiodarone (46%). Electrical cardioversion was performed in 28%. At discharge, only one patient was in AF and five were being treated with a rhythm-control agent that was discontinued at 1-6 months. The independent predictors of postoperative AF were age, bilateral transplant, and a history of preoperative AF.

Conclusions:

The authors concluded that AF is common after lung transplantation, and is not an independent predictor of mortality.

Perspective:

The incidence of postoperative AF in this study is similar to the incidence after open-heart surgery and after other types of noncardiac thoracic surgery. The predominant mechanisms of AF in all of these settings probably are pericardial inflammation and adrenergic activation.

Keywords: Lung Transplantation, Inflammation, Coronary Artery Disease, Stroke, Multivariate Analysis, Hospital Mortality, Electric Countershock, Risk Factors, Thoracic Surgery, Postoperative Period, Heart Failure, Telemetry, Cardiac Surgical Procedures, Hypertension


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