Preexisting atrial fibrillation and cardiac complications after liver transplantation

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it is associated with increased cardiovascular morbidity and all-cause mortality. Our aim was to determine the impact of preexisting AF on patients undergoing liver transplantation (LT). A retrospective case-control study was performed. Records from patients who underwent LT between January 2005 and December 2008 at Mayo Clinic Florida were reviewed. Patients with preexisting AF were identified and matched to patients who did not have a diagnosis of AF. Thirty-two of 717 LT recipients (4.5%) had AF before LT. These patients were compared to a control group of 63 LT recipients. Pre-LT left ventricular hypertrophy (P 5 0.03), a history of congestive heart failure (P 5 0.04), and a history of stroke or transient ischemic attack (P 5 0.03) were significantly more prevalent in patients with AF versus controls. Intraoperative adverse cardiac events (P 5 0.02) and AF-related adverse postoperative events (P < 0.001) were more common in the recipients with known AF. Six patients with paroxysmal AF (19%) developed chronic/ persistent AF postoperatively. Graft survival and patient survival were similar in the groups. Although patients with AF had a higher incidence of intraoperative cardiac events, a higher cardiovascular morbidity rate, and a complicated postoperative course, this did not affect overall graft and patient survival. Liver Transpl 21:314-320, 2015. V C 2014 AASLD. Atrial fibrillation (AF) is the most common cardiac arrhythmia with an estimated incidence of 28.3 per 1000 person-years in the United States. 1 The prevalence of AF is 0.95% to 2.3% in the general population; however, it is more prevalent in men and older individuals. 2-4 AF affects approximately 2.3 million Americans, and it is projected that more than 5.6 million Americans will have this condition by 2050. 3 Liver transplantation (LT) outcomes have improved in the last 2 decades, but cardiovascular complications remain a leading cause of death in LT recipients. 5-7 These complications have been attributed to immunosuppressive regimens and preexisting cardiac disease. 8,9 For this reason, LT candidates undergo an extensive preoperative cardiac assessment to ensure adequate function. 10,11 It is known that AF is associated with an increased risk of stroke, heart failure, and all-cause mortality in the general population; however, the impact of AF on patients undergoing LT is largely unknown. 12,13 Our aim in this study was to determine the morbidity and mortality associated with AF in patients undergoing LT. PATIENTS AND METHODSA retrospective analysis was performed of all patients who underwent LT between January 2005 and December 2008 at our institution. This study was reviewed

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample

“…Atrial fibrillation is the most common cardiac arrhythmia with prevalence estimates ranging from 0.95% to 2.3% in the general population(30) and AF significantly increases cardiovascular and cerebrovascular morbidity, as well as all-cause mortality(31). In a recent single-center study, the prevalence of AF among LT recipients was reported at 4.5% and patients with AF had a higher incidence of intraoperative cardiac events and a higher cardiovascular morbidity rate though there was no impact of AF on overall graft or patient survival(17). Thus, AF may be a marker of risk for future decompensation and should be considered as part of the risk profile in candidate selection.…”

“…Thus, little is known about the impact of non-coronary heart disease, including arrhythmia, heart failure and stroke, on LT outcomes. In one small single center study, preexisting atrial fibrillation (AF) was shown to increase risk of intraoperative cardiac events and cardiovascular morbidity after LT(17), and among the general population AF is associated with an increased risk of stroke, heart failure, and all-cause mortality representing a substantial healthcare burden with high rates of re-hospitalization and healthcare utilization(20). Utilizing data from the Organ Procurement and Transplantation Network (OPTN) we recently demonstrated that CVD in general has surpassed infection and graft failure as the leading cause of early mortality in the United States, accounting for over 40% of deaths within 30 days of LT(1).…”

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

“…3,4 Patients with pre-existing AF have increased intraoperative and postoperative cardiovascular complications, graft dysfunction and mortality. 3,105 AF identified during pre-LT evaluation should prompt investigation for other cardiac pathology. Symptomatic patients or those with uncontrolled ventricular response may benefit from a cardiology consultant for management recommendations.…”

Liver Disease as a Predictor of New‐Onset Atrial Fibrillation

“…It has been suggested that AF is associated with worsened outcomes in the perioperative period and immediate postoperative period in patients undergoing LT 21, 22. Given the findings of this study, AF is likely a marker of illness severity rather than a major cause of poor outcomes.…”