Atrial fibrillation after pulmonary transplant

Although atrial fibrillation or flutter (AF) is thought to occur commonly after pulmonary transplantation, little is known about the epidemiology, risk factors, or clinical significance of arrhythmia in this population. The aim of the current study was to determine the incidence, clinical predictors, and associated morbidity of AF after lung transplant.

The records of 200 consecutive adult patients who underwent lung transplantation at a single institution from August 1998 to June 2002 were studied. Multivariate logistic regression analysis was performed to define the predictors for posttransplant AF.

Indications for transplant included COPD in 43%, cystic fibrosis in 18%, and idiopathic pulmonary fibrosis (IPF) in 17%. The transplants were bilateral (79%) or single lung (21%). The mean age of the patients was 50 years (range, 19 to 66 years; median, 54 years). Postoperative AF within 14 days of transplant occurred in 78 patients (39%), with a mean onset of 3.8 +/- 3.0 days (+/- SD). Significant predictors of AF were as follows: age >or= 50 years (odds ratio [OR], 2.1; p = 0.01), IPF (OR, 2.3; p = 0.03), existing coronary disease (OR, 2.0; p = 0.009), enlarged left atrium (LA) on echocardiography (OR, 3.9; p = 0.05), and number of postoperative vasopressors (OR, 1.5; p = 0.03). Patients with AF had longer hospital stays (32.4 +/- 60.0 days vs 17.5 +/- 24.1 days, p = 0.04), were more likely to undergo tracheostomy (OR, 3.6; p = 0.0003), and had more in-hospital deaths (OR, 5.7; p = 0.0005) than patients without AF.

AF is a frequent complication after lung transplant. Advanced age, IPF, known coronary disease, enlarged LA, and use of postoperative vasopressors increase the risk for developing AF. The development of posttransplant AF is associated with significantly prolonged hospital stay and increased mortality. Prospective studies designed to prevent posttransplant AF are needed to clarify the extent to which AF impacts on posttransplant outcomes.