Korean J Intern Med.  2020 Jul;35(4):897-905. 10.3904/kjim.2018.326.

Clinical significance of postoperative atrial arrhythmias in patients who underwent lung transplantation

• Kim BG
• Uhm JS
• Yang PS
• Yu HT
• Kim TH
• Joung B
• Pak HN
• Kim SY
• Park MS
• Lee JG
• Paik HC
• Lee MH

• KMID: 2504181
• DOI: http://doi.org/10.3904/kjim.2018.326

Abstract

Background/Aims
Atrial arrhythmia (AA) occasionally occurs after lung transplantation (LT); however, risk factors for AA and their impact on clinical outcomes are inconsistent. We aimed to investigate the incidence, predisposing factors, and clinical outcomes of AA after LT.
Methods
We retrospectively evaluated 153 consecutive patients who underwent LT between January 2010 and August 2016. An AA episode was defined as a documented atrial fibrillation (AF), atrial flutter, or atrial tachycardia on 12-lead electrocardiography or episodes lasting ≥ 30 seconds on telemetry monitoring.
Results
The mean follow-up time was 22.0 ± 19.1 months. Postoperative AA occurred in 46 patients (30.1%) after LT. Patients with postoperative AA were older, had larger body surface area, and had an increased incidence of paroxysmal AF prior to transplantation, idiopathic pulmonary fibrosis, and postoperative tracheostomy than patients without AA. Preoperative right atrial pressure (RAP) (odds ratio [OR], 1.19; p = 0.005) and longer periods of mechanical ventilation (OR, 1.03; p = 0.008) were found to be independent risk factors for AA after surgery. Development of AA was a significant predictor of long-term overall mortality (hazard ratio, 2.75; p = 0.017).
Conclusions
Patients with elevated preoperative RAP and long-term ventilator care had a higher risk of AA after LT. Further, AA after LT was associated with poor long-term survival.

Keyword

Lung transplantation; Atrial fibrillation; Atrial f lutter; Tachycardia, ectopic atrial; Survival