TY - JOUR
T1 - Atrial Flutter and Fibrillation Following Lung Transplantation
T2 - Incidence, Associations and a Suggested Therapeutic Algorithm
AU - Barnes, Hayley
AU - Gurry, Greta
AU - McGiffin, David
AU - Westall, Glen
AU - Levin, Kovi
AU - Paraskeva, Miranda
AU - Whitford, Helen
AU - Williams, Trevor
AU - Snell, Greg
PY - 2020/10
Y1 - 2020/10
N2 - Background: Atrial arrhythmias are relatively common following lung transplantation and confer considerable perioperative risk, specifically haemodynamic instability, pulmonary congestion, dyspnoea, and can mask other post-transplant complications such as infection or acute rejection. However, for most patients, arrhythmias are limited to the short-term perioperative period. Methods: We present a retrospective case-control analysis of 200 lung transplant recipients and using multivariate regression analysis, document the present incidence, risk factors, and outcomes between the two groups. Results: Twenty-five per cent (25%) of lung transplantation patients developed atrial flutter or fibrillation, most frequently at day 5–7 post lung transplantation, and more commonly present in older recipients and those with underlying chronic obstructive pulmonary disease (COPD), but not in those with previously noted structural heart disease, or in those undergoing single rather than double lung transplants. Atrial arrhythmias were associated with increased intensive care unit and overall length of stay, but were not associated with increased risk of in-hospital stroke, or mortality. Based on our experience, we propose a suggested management algorithm for pharmacological and mechanical rate/rhythm control strategies, for anticoagulation, and discuss the appropriate duration of treatment. Conclusions: Atrial arrhythmias are relatively common post lung transplantation. Carefully managed, the associated risk of perioperative morbidity and mortality can be mitigated. Further prospective studies are required to validate these strategies.
AB - Background: Atrial arrhythmias are relatively common following lung transplantation and confer considerable perioperative risk, specifically haemodynamic instability, pulmonary congestion, dyspnoea, and can mask other post-transplant complications such as infection or acute rejection. However, for most patients, arrhythmias are limited to the short-term perioperative period. Methods: We present a retrospective case-control analysis of 200 lung transplant recipients and using multivariate regression analysis, document the present incidence, risk factors, and outcomes between the two groups. Results: Twenty-five per cent (25%) of lung transplantation patients developed atrial flutter or fibrillation, most frequently at day 5–7 post lung transplantation, and more commonly present in older recipients and those with underlying chronic obstructive pulmonary disease (COPD), but not in those with previously noted structural heart disease, or in those undergoing single rather than double lung transplants. Atrial arrhythmias were associated with increased intensive care unit and overall length of stay, but were not associated with increased risk of in-hospital stroke, or mortality. Based on our experience, we propose a suggested management algorithm for pharmacological and mechanical rate/rhythm control strategies, for anticoagulation, and discuss the appropriate duration of treatment. Conclusions: Atrial arrhythmias are relatively common post lung transplantation. Carefully managed, the associated risk of perioperative morbidity and mortality can be mitigated. Further prospective studies are required to validate these strategies.
KW - Arrhythmia
KW - Atrial fibrillation
KW - Lung transplantation
KW - Perioperative risk
UR - http://www.scopus.com/inward/record.url?scp=85076545673&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2019.10.011
DO - 10.1016/j.hlc.2019.10.011
M3 - Article
C2 - 31786113
AN - SCOPUS:85076545673
SN - 1443-9506
VL - 29
SP - 1484
EP - 1492
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 10
ER -