Atrial fibrillation before heart transplantation is a risk factor for post‐transplant atrial fibrillation and mortality

Abstract

Aims Atrial fibrillation (AF) after heart transplantation (HTX) is associated with worse clinical outcomes. The current study aimed to analyse the association between AF before HTX and AF within 30 days after HTX. Methods and resultsThis study included 639 adults who received HTX at Heidelberg Heart Center. Patients were subdivided into four groups depending on the status of AF before and after HTX. Analyses comprised recipient and donor data, medication, echocardiographic features, permanent pacemaker implantation, stroke, and mortality after HTX. Three hundred thirty-two patients (52.0%) had neither AF before nor after HTX, 15 patients (2.3%) had no AF before HTX but showed AF after HTX, 219 patients (34.3%) showed AF before HTX but had no AF after HTX, and 73 patients (11.4%) had AF before and after HTX. Patients with AF before and after HTX had a higher 1 year post-transplant mortality (39.7%) than patients without AF before or after HTX (18.1%, P < 0.01). Secondary outcomes showed a higher percentage of enlarged atria, ventricular dysfunction, mitral regurgitation, 1-year stroke, and 1-year permanent pacemaker implantation in patients with AF before and after HTX. Multivariate analysis revealed a six-fold elevated risk for post-transplant AF in patients with AF before HTX (hazard ratio: 6.59, confidence interval: 3.72-11.65; P < 0.01). Further risk factors for post-transplant AF were higher donor age and prolonged ischaemic time, whereas total orthotopic HTX was associated with a two-fold lower risk for post-transplant AF. Conclusions Atrial fibrillation before HTX is a risk factor for post-transplant AF, permanent pacemaker implantation, and mortality after HTX.

Pre-transplant Type 2 Diabetes Mellitus Is Associated With Higher Graft Failure and Increased 5-Year Mortality After Heart Transplantation

“…Written informed consent was obtained from patients for inclusion in the Heidelberg HTX Registry allowing the clinical and scientific use of data. According to the ethical approval, no additional written informed consent was required for this observational study as merely routine clinical data were analyzed ( 26 – 35 ).…”

“…After hospital discharge, patients were monthly seen at the HTX outpatient-clinic during the first six post-transplant months, then bimonthly until the end of the first year after HTX, and thereafter three to four times annually (with additional visits when clinically required). Routine follow-up included medical history, physical examination, 12-lead electrocardiogram, echocardiography, endomyocardial biopsy, and blood tests including immunosuppressive drug monitoring ( 26 – 35 ).…”

“…From 2001 onward, mycophenolate mofetil subsequently replaced azathioprine, and tacrolimus consecutively replaced cyclosporine A from 2006 onward. Steroids were tapered incrementally during the initial post-transplant months and were discontinued 6 months after HTX (unless clinically needed) ( 26 – 35 ).…”

“…The Kaplan–Meier estimator was used to graphically show 5-year post-transplant survival. A P -value of < 0.050 was considered statistically significant ( 26 – 35 ).…”

“…We did not include additional parameters in this multivariate analysis for 5-year mortality after HTX in order to avoid biased regression coefficients and to ensure a stable number of events (deceased patients) per analyzed variable. Given the long study period (01/01/2000–01/10/2016), we additionally performed a sensitivity analysis to test the robustness of our findings and to examine a possible era effect using a subgroup of patients with tacrolimus and mycophenolate mofetil as the immunosuppressive drug regimen was changed from 2006 onward ( 26 – 35 ).…”