Atrial Fibrillation After Pulmonary Transplantation Incidence, Impact on Mortality, Treatment Effectiveness, and Risk Factors

Background —Atrial fibrillation (AF) is common following thoracic surgery. Limited data exist concerning the incidence of AF, its impact on mortality, the effectiveness of therapy and the risk factors of AF after pulmonary transplantation. Methods and Results —We reviewed the medical files of 224 consecutive lung transplant recipients who underwent surgery over a 10-year period at a large Canadian centre. We collected patient characteristics, in-hospital treatments and outcomes. Time-to-event analysis was used to account for in-hospital follow-up, and models generated to assess the impact of AF on mortality and independent risk factors of AF following transplantation. Postoperative AF occurred in 65 patients (29%). AF was more likely to occur with complications such as pneumonia, mediastinitis and bronchial dehiscence and was not an independent risk factor of mortality (Hazard Ratio (HR)=1.56; 95% confidence interval (CI) 0.52-4.63). Pharmacological or electrical therapy for rhythm or rate control of AF was administered to 97% of patients. Intravenous amiodarone was used in 46%, electrical cardioversion in 28% and heparin in 26%. Only 1 patient remained in AF at discharge. Age (HR=1.08 by year; 95%CI 1.05-1.12), bilateral transplantation (HR=1.87; 95%CI 1.03-3.42) and a history of AF prior to the transplantation (HR=4.48; 95%CI 1.05-19.11) were found to be independently associated with an increased incidence of post-operative AF. Conclusions —AF is fairly common after pulmonary transplantation, transient and relatively benign. It is not independently associated with increased in-hospital mortality. Most patients return to sinus rhythm before discharge. Age, prior AF and bilateral transplantation increase the risk of postoperative AF.