Early and Late Atrial Arrhythmias After Lung Transplantation　― Incidence, Predictive Factors and Impact on Mortality ―

Abstract

atrium. Several predictive factors of postoperative AA after LT have already been identified whereas those of late AA are still unknown. Whether AA after LT has an effect mortality and the optimal strategy of rhythm management are still being debated. 7- 9 The purpose of our study was to assess in a large cohort of LT patients the incidence, management and outcome of AA early and late after surgery, the predictive factors and effect on mortality. Methods Study DesignAll consecutive patients who underwent LT between January 2005 and December 2014 were prospectively followed at the Nouvel Hôpital Civil of Strasbourg, A trial arrhythmias (AAs) are commonly observed immediately after thoracic surgery and may occur in up to 20-40% of procedures. 1-3 Postoperative AAs are related to age, hypertension, stress, use of inotropes or postoperative pain, and are associated with longer hospital stay and deaths. 1, 4 The incidence of AA is higher after lung transplantation (LT) than after heart transplantation, in part because of cardiac autonomic denervation. 5 LT patients are usually younger with less cardiovascular risk factors than patients undergoing other thoracic surgery. 6 AAs are observed early and also late after LT. Double LT is associated with long-term freedom from paroxysmal atrial fibrillation (AF). 7 Atrial tachycardias, focal or macroreentrant are probably related to surgical lines around the pulmonary veins (PVs) between the donor and the recipient left Whether AA after LT affects mortality is still being debated. This study assessed in a large cohort of LT patients the incidence of AAs early and late after surgery, their predictive factors and their effect on mortality.

Outcomes of lung transplant recipients with preoperative atrial fibrillation

“…The incidence of postoperative AF in our study group was 21.7% and the incidence of any atrial arrhythmia was 29%, which are lower than the incidences reported by other investigators. 10,11 A recent study by Jesel and colleagues 10 reported that 33% of their patients experienced postoperative atrial arrhythmias; 39% of patients in a study by Nielsen and colleagues 11 experienced the same. The underlying mechanisms of postoperative AF include inflammation, hemodynamic stress, electrolyte abnormalities, and neurohormonal imbalance with resultant changes in atrial conduction and refractoriness.…”

Late atrial arrhythmias after lung transplantation: a meta-analysis

“…11 studies were excluded since they focused on early AFib occurrence after LT, while 6 studies were excluded since they were case reports (Figure 1). Finally, 7 studies were included in the present systematic review and meta-analysis [6][7][8][9][10][11][12] encompassing 2,068 patients (Table 1). Time cut-offs for defining arrhythmia occurrence as "late" are also reported in Table 1.…”

Clinical significance of postoperative atrial arrhythmias in patients who underwent lung transplantation

“…These findings are in agreement with the results reported by Orrego et al [ 3 ], which demonstrated a higher 12-month overall mortality in those who developed AA, but not at 90 days. Despite conflicting results of the impact of postoperative AA on long term survival after LT [ 11 , 21 ], a recent meta-analysis demonstrated that the occurrence of AA after LT has prognostic implications for overall long-term survival [ 22 ]. Taken together, these results suggest that development of AA after LT may not influence short-term mortality, but likely affects overall long-term mortality.…”