Background: Little is known about the frequency of, risk
factors predisposing to, and long-term impact of post-operative atrial
fibrillation (AF) after lung transplantation.
Methods: A prospectively collected registry of 167
consecutive patients who underwent single or bilateral lung transplantation at
the University of Minnesota Medical Center from January 1st, 2004 to
December 30th, 2008 was reviewed. Post-operative AF was confirmed by
review of electrocardiograms by two cardiologists. Kaplan-Meier survival curves
were constructed to determine the impact of new onset AF on long-term survival
Results: The mean age (±SD) of the population was 55 ± 11
years and 52% were male. A total of 48 patients (28%) developed AF in the
postoperative period. Predictors of postoperative AF in multivariate analysis
included: age (per decade) Odds Ratio (OR): 1.61, 95% confidence interval (CI)
1.10-2.34, p=0.01, postoperative thromboembolic disease OR: 9.73 (95% CI:
2.16-43.81, p<0.01, and postoperative pericarditis OR: 3.57, (95% CI:
1.38-9.22, p < 0.01). Of the 48 patients who developed post-operative AF, 41
were discharged in sinus rhythm (SR). Survival among patients who were
discharged in AF was significantly lower when compared to patients discharged
in SR (HR: 0.08; 0.01-0.43, p<0.05).
Conclusions: Postoperative AF is common after lung transplant.
Increased age, postoperative thromboembolic disease, and pericarditis are
independent predictors of postoperative AF. Persistence of AF at the time of
discharge is an identifier of decreased survival.
Credits: Santiago Garcia, MD; Mariana Canoniero, MD; Srinivasan Sattiraju, MD; Lin Y. Chen, MD; Wayne Adkisson, MD; Marshall Hertz, MD; David G. Benditt, MD