Prevalence, Pathophysiology, and Clinical Significance of Post-heart Transplant Atrial Fibrillation and Atrial Flutter

Ahmari, Saeed Al; Bunch, T. Jared; Chandra, Ankur; Chandra, Vidhan; Ujino, Keiji; Daly, Richard C.; Kushwaha, Sudhir S.; Edwards, Brook; Maalouf, Youssef; Seward, James B.; McGregor, Christopher G.A.; Chandrasekaran, Krishnaswamy

doi:10.1016/j.healun.2005.07.017

Cited by 81 publications

(81 citation statements)

References 22 publications

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“…Inflammation has been associated with AF, and a higher inflammatory state after surgery may explain the higher incidence of AF early but not late in our cohort. 7,21 AF, AFL, and AT have been described after thoracic surgery and after LT. 2,20,[22][23][24][25] Left AFL has also been described after LT in the pediatric population and after orthotopic heart transplantation. 25,26 The donor PV-left atrial cuff anastomosis with the recipient LA results in putative lines of conduction block that serve as potential substrate for macroreentrant tachyarrhythmia while possibly also compartmentalizing the LA to reduce the incidence of AF.…”

Section: Discussionmentioning

confidence: 99%

Atrial Arrhythmias After Lung Transplantation

See

Roberts‐Thomson

Stevenson

et al. 2009

Circ: Arrhythmia and Electrophysiology

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Background-Atrial arrhythmias (AAs) including atrial fibrillation (AF) and atrial tachycardia (AT) are often observed after cardiothoracic surgery. Our aim was to evaluate the prevalence and mechanism of AAs after lung transplantation. Methods and Results-All patients (nϭ127) after bilateral sequential lung transplantation followed at our institution over 20 years were included. All patients received postoperative rhythm monitoring and clinic visits with ECG at 1, 3, 6, and 12 months, or as needed. AAs occurred in 40 of 127 (31.5%) patients over 4.2Ϯ4.1 years. AA prevalence at postoperation and 1, 3, 6, 12, and Ͼ12 months was 24%, 11%, 3%, 2%, 4%, and 11%, respectively. Early AAs were predominantly AF, whereas all AAs Ͼ12 months were AT. Time to first AF versus AT was 11Ϯ9 versus 1485Ϯ2462 days (Pϭ0.09). Male sex, age, and preoperative AA predicted any early (Ͻ3 months) AA but did not predict late AA. Early AA did not predict late AT. In 4 patients with drug-resistant AT, electrophysiology studies found AT involving the pulmonary vein/left atrium anastomoses in 3 patients, including donor-to-recipient conduction in 1, border zone macroreentry in 2, and cavotricuspid isthmus dependent flutter in 1; all patients were successfully treated with ablation. Conclusions-AAs after lung transplantation are common. Although AF is common early, AF is rare after healing of left atrial incisions, which probably result in surgical pulmonary vein isolation with rare exception. This raises the question of whether additional surgical or ablation lines at the time of lung transplantation would prevent late AA. (Circ Arrhythmia Electrophysiol. 2009;2:504-510.)

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Section: Discussionmentioning

confidence: 99%

Atrial Arrhythmias After Lung Transplantation

See

Roberts‐Thomson

Stevenson

et al. 2009

Circ: Arrhythmia and Electrophysiology

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“…9 Postoperative AF in heart transplant patients carries different clinical implications and is related to death and rejection. 19 Recently, Gillinov et al compared rate vs. rhythm control for AF after cardiac surgery and showed no net clinical advantage of 1 treatment strategy over the other. 20 In our experience, rhythm control strategy was used in the majority of patients without significant complications and could constitute a reasonable first-line approach for these patients.…”

Section: Discussionmentioning

confidence: 99%

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

Jesel

Barraud

Lim

et al. 2017

Circ J

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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.

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“…Previous studies demonstrated that about a quarter of these patients developed SVT attributed to macro-reentrant tachycardia, and about 4% underwent EP studies [2,3]. Anesthesia for ablation procedures in these patients mandate several considerations including transplant technique used, interventional cardiology procedure performed, and particular complications common to post transplant patients.…”

Section: Discussionmentioning

confidence: 99%

“…As a result of an increasing number of patients surviving cardiac transplantation and the relatively high incidence of atrial arrhythmias in these patients, ablation procedures under anaesthesia may be required [2,3]. Percutaneous catheter ablation is done with applying electrical triggers around the pulmonary vein ostia in order to accomplish pulmonary vein isolation using radiofrequency current.…”

Section: Introductionmentioning

confidence: 99%

Anaesthesia Management for Ablation Therapy in Post Heart Transplant Arrhythmia

Prapaitrakool¹,

Bainbridge²,

Lavi³

2013

OJAnes

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In this case series we describe the anaesthetic management of atrial ablation for arrhythmia in three post heart transplant patients. These patients provide a unique challenge to the anaesthesiologist, as heart physiology, end organs effects, procedural related factors should all be part of the specific anaesthetic plan tailored for each patient individually. The different anaesthetic techniques applied, and procedure related complications are evaluated. Anaesthetic management, procedural related difficulties, pharmacologic aspects, and possible associated complications are reviewed.

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Prevalence, Pathophysiology, and Clinical Significance of Post-heart Transplant Atrial Fibrillation and Atrial Flutter

Cited by 81 publications

References 22 publications

Atrial Arrhythmias After Lung Transplantation

Atrial Arrhythmias After Lung Transplantation

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

Anaesthesia Management for Ablation Therapy in Post Heart Transplant Arrhythmia

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Prevalence, Pathophysiology, and Clinical Significance of Post-heart Transplant Atrial Fibrillation and Atrial Flutter

Cited by 81 publications

References 22 publications

Atrial Arrhythmias After Lung Transplantation

Atrial Arrhythmias After Lung Transplantation

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

Anaesthesia Management for Ablation Therapy in Post Heart Transplant Arrhythmia

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