Clinical significance of postoperative atrial arrhythmias in patients who underwent lung transplantation
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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.
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.
참고문헌 (22)
- Yusen RD, "The Registry of the International Society for Heart and Lung Transplantation:thirtieth adult lung and heart-lung transplant report. 2013. Focus theme: age", J Heart Lung Transplant, 32, pp.965~978 (2013)
- Christie JD, "Registry of the International Society for Heart and Lung Transplantation:twenty-fifth official adult lung and heart", lung transplantation report. 2008, 2008, pp.27, 957~969
- Orrego CM, "Atrial arrhythmias after lung transplant: underlying mechanisms, risk factors, and prognosis", J Heart Lung Transplant, 33, pp.734~740 (2014)
- See VY, "Atrial arrhythmias after lung transplantation : epidemiology, mechanisms at electrophysiology study, and outcomes", Circ Arrhythm Electrophysiol, 2, pp.504~510 (2009)
- Chaikriangkrai K, "Incidence, risk factors, prognosis, and electrophysiological mechanisms of atrial arrhythmias after lung transplantation", JACC Clin Electrophysiol, 1, pp.296~305 (2015)
- Isiadinso I, "Atrial arrhythmias after lung and heart-lung transplant : effects on short-term mortality and the influence of amiodarone", J Heart Lung Transplant, 30, pp.37~44 (2011)
- D’Angelo AM, "Atrial arrhythmias after lung transplantation : incidence and risk factors in 652 lung transplant recipients", J Thorac Cardiovasc Surg, 152, pp.901~909 (2016)
- Nielsen TD, "Atrial fibrillation after pulmonary transplant", Chest, 126, pp.496~500 (2004)
- Mason DP, "Atrial fibrillation after lung transplantation : timing, risk factors, and treatment", Ann Thorac Surg, 84, pp.1878~1884 (2007)
- Malik A, "Elevated pulmonary artery systolic pressures are associated with a lower risk of atrial fibrillation following lung transplantation", J Electrocardiol, 46, pp.38~42 (2013)
- Henri C, "Atrial fibrillation after pulmonary transplantation : incidence, impact on mortality, treatment effectiveness, and risk factors", Circ Arrhythm Electrophysiol, 5, pp.61~67 (2012)
- Eberlein M, "Lung allocation in the United States", Clin Chest Med, 32, pp.213~222 (2011)
- Uhm JS, "Intra-atrial reentrant tachycardia originating from the pulmonary vein cuff anastomosis in a lung transplantation patient : ultra-high-density 3-dimensional mapping", HeartRhythm Case Rep, 4, pp.152~154 (2018)
- Azadani PN, "Frequency of atrial flutter after adult lung transplantation", Am J Cardiol, 107, pp.922~926 (2011)
- Echahidi N, "Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery", J Am Coll Cardiol, 51, pp.793~801 (2008)
- Bazaz R, "A novel strategy for prevention of post-operative atrial arrhythmias in patients undergoing lung transplantation", J Heart Lung Transplant, 29, pp.713~715 (2010)
- Maesen B, "Post-operative atrial fibrillation : a maze of mechanisms", Europace, 14, pp.159~174 (2012)
- Shingu Y, "Postoperative atrial fibrillation : mechanism, prevention, and future perspective", Surg Today, 42, pp.819~824 (2012)
- Dizon JM, "A comparison of atrial arrhythmias after heart or double-lung transplantation at a single center : insights into the mechanism of post-operative atrial fibrillation", J Am Coll Cardiol, 54, pp.2043~2048 (2009)
- Shekerdemian L, "Cardiovascular effects of mechanical ventilation", Arch Dis Child, 80, pp.475~480 (1999)
- Jesel L, "Early and late atrial arrhythmias after lung transplantation : incidence, predictive factors and impact on mortality", Circ J, 81, pp.660~667 (2017)
- Fan J, "Incidence, risk factors and prognosis of postoperative atrial arrhythmias after lung transplantation: a systematic review and meta-analysis", Interact Cardiovasc Thorac Surg, 23, pp.790~799 (2016)