Atrial fibrillation following heart transplantation: A systematic review and meta‐analysis of observational studies

Abstract

Objective: Previous studies have suggested a high incidence of atrial fibrillation (AF) in heart transplant recipients. However, incidence trends of AF in heart transplant recipients remain unclear. The study's aims were (1) to investigate the pooled incidence/incidence trends of AF following heart transplantation and (2) to assess the mortality risk of heart transplant recipients with AF. Methods:A literature search for studies that reported the incidence of AF following heart transplantation was conducted using MEDLINE, EMBASE, and The Cochrane Database from inception through March 2018. Pooled incidence and odds ratios (OR) with 95%CI were calculated using a random-effects model. Results:Eighteen studies (2 cohorts from clinical trials and 16 cohort studies) with 5393 heart transplant recipients were enrolled. The pooled estimated incidence of AF in heart transplant was 10.1% (95%CI: 7.6%-13.2%). Meta-analysis based on the type of anastomotic technique demonstrated a pooled estimated incidence of AF following heart transplantation of 18.7% (95%CI: 10.3%-31.5%) and 11.1% (95%CI: 6.5%-18.4%) by biatrial and bicaval techniques, respectively.There was a significant association between AF following a heart transplant and increased mortality risk with a pooled OR of 2.86 (95%CI: 2.08-3.93). Meta-regression analyses showed no significant correlations between the year of study and incidence of AF (P = 0.47) or mortality risk of AF after heart transplantation (P = 0.99). Conclusions:The overall estimated incidence of AF following heart transplantation is 10.1%.There is a significant association between AF and increased mortality after transplantation. Furthermore, incidence and mortality risk of AF following heart transplant does not seem to decrease over time. K E Y W O R D Satrial fibrillation, cardiac, heart, meta-analysis, transplant, transplantation is almost 90% with a median survival rate over 10 years. [2][3][4]

Atrial fibrillation after orthotopic heart transplantatation: Pathophysiology and clinical impact

“…Vaseghi et al [21] suggested a potential involvement of parasympathetic re-innervation, but without reporting an objective demonstration, while a recent case report described PVs reconnection several years after OHT as a cause of atrial tachyarrhythmia [31] . As previously described [8] , [16] , [21] , [22] , we observed a significantly higher mortality in patients with AF episodes, confirmed by Kaplan Meyer and Cox regression analysis. It is known that an old age recipient with rejection episodes has higher mortality, but if the patient experienced AF episodes, its outcome gets worse.…”

“…The reported rate of AF in the transplanted heart ranges between 0.3% [15] and 24% [16] and this variation might be due to the methods used for arrhythmia detection. In a recent review, the overall estimated rate was 10% [8] . In this study, the total rate was 23.4%, similar to the results reported by Pavri et al [16] with a comparable cohort.…”

“…Both techniques isolate the muscle sleeve of the PVs from the recipient. Previous studies showed controversial results about the rate of AF cases after OHT, the relative predisposing factors and long-term outcome [8] . In this study, we investigated the rate of AF in OHT as a model of complete PVs isolation and autonomic denervation, identifying the risk factors related to the development of the arrhythmia and evaluating the impact of AF episodes on the prognosis.…”

Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality

“…Lushaj and colleagues 5 found no difference between patients with (6.5%) or without (7.1%, P = 0.76) amiodarone before HTX regarding post‐transplant AF, which could be a result of their lower overall incidence of post‐transplant AF (6.8%). A recent Cochrane meta‐analysis 47 reported a higher overall incidence of AF after HTX of 10.1%, which is in line with our findings.…”

The 100 Top-Cited Systematic Reviews/Meta-Analyses on Diabetic Research

“…Systematic reviews/meta-analyses use systematic methods to collect secondary data, critically appraise research studies, and synthesize studies [ 11 , 21 – 27 ]. They are designed to provide a complete, exhaustive summary of current evidence relevant to a research question and are the key to the practice of evidence-based medicine and have always been used in practice guideline [ 28 – 30 ]. Assessment of quality and quantity of diabetic systematic reviews/meta-analyses by bibliometrics analysis should be very important for diabetic research.…”