Arrhythmias after pediatric lung transplantation

Abstract

Atrial arrhythmias have been reported after congenital heart surgery involving extensive atrial suture lines. Experimental studies involving bilateral lung transplantation (Tx) suggest that the left atrial suture lines predispose to atrial flutter. The overall incidence and type of arrhythmias after pediatric lung Tx have not previously been described and therefore the purpose of this study was to prospectively screen and describe arrhythmias in a subset of our lung transplant population. Over a 1-yr study period, all recipients of bilateral lung Tx were admitted to a full-disclosure telemetry unit. Single-lead electrocardiograms were recorded continuously and reviewed daily via a beat-by-beat analysis. A total of 314 patient days (range 9-93, median 43 days) were recorded from seven patients. The incidence of arrhythmias observed per total patient days included junctional escape rhythm (4.8%), non-sustained ventricular tachycardia (4.1%), accelerated junctional (2.5%), sinus bradycardia (2.2%), non-sustained supraventricular tachycardia (1.3%), ectopic atrial tachycardia (1.0%), sustained ventricular tachycardia (0.3%), junctional ectopic tachycardia (0.3%), and second degree heart block (0.3%). No patient had sustained supraventricular tachycardia, atrial flutter, atrial fibrillation, or complete heart block. Arrhythmias were treated in two patients. During the follow-up period, one patient received amiodarone for ventricular tachycardia (which was also noted and treated prior to transplant). We conclude that among pediatric lung transplant recipients admitted for their transplant surgery, arrhythmia is uncommon and rarely requires therapy.

Atrial Arrhythmias After Lung Transplantation

“…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.…”

Atrial tachyarrhythmias after lung transplantation in children: A common occurrence

“…Investigations of arrhythmias following pediatric lung transplant patients are sparse and show mixed results. Gandhi et al found an 11% incidence of atrial flutter following lung transplantations, whereas Hoffman et al reported an arrhythmia risk of <5% in a small cohort of patients 13,14 . Given the lack of data, we set out to evaluate our lung transplant patients with a specific focus on the impact of AAs.…”

“…Within the pediatric lung transplant population, there is a paucity of data on the development of AAs. In the limited data that do exist, some have concluded that the prevalence and significance is low, while others have seen arrhythmias with some routine 13,14 . At our local institution, we noted that AAs following lung transplant was not uncommon and thus sought to evaluate this patient population further.…”

“…In the limited data that do exist, some have concluded that the prevalence and significance is low, while others have seen arrhythmias with some routine. 13,14 At our local institution, we noted that AAs following lung transplant was not uncommon and thus sought to evaluate this patient population further. The goal of the study was to determine the incidence of AAs following lung transplant in children, evaluate for risk factors, and to describe their clinical impact.…”

Atrial arrhythmias following lung transplant: a single pediatric center experience

“…One of commonly recognized postoperative complications in adults after LTx is atrial arrhythmias with reported prevalence up to 50%, leading to increased length of hospital stay and mortality (8)(9)(10)(11)(12)(13). Compared to adults, published data on atrial arrhythmias among children and young adults following LTx are sparse with reported prevalence rates of 11%-20% across pediatric LTx centers (14)(15)(16). Given the changing pediatric LTx landscape, optimization of clinical management of pediatric LTx recipients is a priority, especially in the post-operative time period until discharge (17,18).…”