Incidence of Atrial Fibrillation in Heart Transplant Patients: Long‐Term Follow‐Up

Abstract

In a cohort study of transplant and low-risk CABG patients, the strongest independent predictor of freedom from AF is having undergone transplant surgery. One potential explanation for the markedly lower incidence of AF may be effective isolation of thoracic veins with documented cases retaining the native SVC.

Supraventricular Tachycardia After Orthotopic Cardiac Transplantation

“…Whereas AFL has also been described in stable transplant patients (14 -18), the mechanisms and occurrence of AF in patients without the aforementioned conditions are not clear. In fact, in 1 study, heart transplantation was an independent predictor of freedom from post-operative AF when compared with patients with other cardiac surgeries (19). Nevertheless, a rare case of AF in the absence of rejection or vasculopathy has been described (20).…”

Atrial Tachyarrhythmias After Cardiac Transplantation

“…Data from the Cleveland Clinic demonstrate a markedly lower incidence of postoperative AF among cardiac transplant recipients when compared with lowrisk coronary bypass surgery patients. 11 This observation is not surprising because atrial ectopy originating from muscular sleeves within the pulmonary veins are known to represent an important trigger for AF. 12 These findings provide an example of an antiarrhythmic modification of atrial substrate resulting from cardiac transplant surgery, albeit nonintended.…”

“…5,6,11 Obligatory pulmonary vein isolation and vagal denervation of the transplanted heart are thought to represent important mechanisms yet there are no definitive data to confirm either principle. The clinical experience of cardiac transplant surgeons and cardiologists has led to the long-standing belief that AF occurring in the transplanted heart is pathognomonic for allograft rejection, purportedly resulting from an acute increase in atrial ectopy and heterogeneity of conduction resulting from the inflammatory myopathy.…”

Arrhythmias in the Heart Transplant Patient

“…Khan et al 1 did not find any association with rejection, but the Cui et al 17 study yielded a clear link when mild rejection (Grade 1-2 of the International Society for Heart and Lung Transplantation classification 18 ) was also considered. In contrast to AF, no study has shown increased mortality in OHT patients experiencing AFL.…”

“…Thus, post-operative OHT AF or AFL (POAF, POAFL) is not a common finding compared with other thoracic surgeries. Indeed, Khan et al 1 first compared the incidence of AF, AFL and other SVTs in heart transplant versus matched low-risk coronary artery bypass graft (CABG) patients. They demonstrated that the OHT group had uncommon AT (0.3 % AF + 2.8 % AFL) when compared with CABG (25 % AF + 17 % AFL), and interestingly, 'other SVT' cases were not so different between two groups (1.3 versus 4.3 %, respectively).…”