Atrial Arrhythmias After Lung Transplantation

Abstract

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.)

Atrial Fibrillation After Pulmonary Transplantation

“…9,[12][13][14] It is the second largest series after that of Mason et al, 13 which reported a lower incidence of 20%. Dizon et al 12 compared the incidence of AF after lung or heart transplant.…”

“…9,[12][13][14] Only 1 series assessed the independent role of identified risk factors. 9 Concurrent postoperative complications may affect to a greater extent the short-term prognosis of these patients.…”

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

“…See et al also described 4 patients who underwent electrophysiological study, with 1 CTI, 2 left-sided macroreentrant tachycardia, and 1 focal atrial tachycardia being diagnosed. 2 Catheter ablation may indeed be useful in this category of LT patients with recurrent AFL.…”

Editorial commentary: What can lung transplantation teach us about the mechanisms of atrial arrhythmias?

“…An interesting subset of lung transplant patients may have atrial tachycardias using donor-to-recipient conduction across an anastomotic line. This has been supported by 2 case reports [3,15] but disputed by some studies including a series of 25 patients in whom electrophysiological mapping showed that all PV antral arrhythmias arose from recipient not donor myocardium [16]. …”

“…Atrial arrhythmias in the early post-operative period are mostly AF, whereas late arrhythmias are mostly atrial tachycardias (AT) [3]. It is unclear if these phenotypes reflect differences in the physiological milieu, e.g., higher autonomic tone or inflammation in the early post-operative period vs. the formation of structural barriers enabling subsequent stable re-entrant or focal atrial tachycardias in the later period.…”