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Published on: February 26, 2013
Preexisting atrial fibrillation and cardiac complications after liver transplantation
Johannes Bargehr1, Jorge F Trejo-Gutierrez, Tushar Patel
1Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL; Division of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL.
Insights
Patients with atrial fibrillation (AF) undergoing liver transplantation (LT) experienced more cardiac events and complications. However, pre-existing AF did not impact overall graft or patient survival rates after LT.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Atrial fibrillation (AF) is a common cardiac arrhythmia linked to increased cardiovascular risks.
- Liver transplantation (LT) is a life-saving procedure for end-stage liver disease.
- The impact of pre-existing AF on LT outcomes requires further investigation.
Purpose of the Study:
- To evaluate the influence of pre-existing atrial fibrillation on liver transplant recipients.
- To compare cardiovascular complications and survival rates between LT patients with and without AF.
Main Methods:
- Retrospective case-control study.
- Analysis of LT recipients between 2005-2008 at Mayo Clinic Florida.
- Matching of patients with pre-existing AF to a control group without AF.
Main Results:
- 4.5% of LT recipients had pre-existing AF.
- Patients with AF showed higher prevalence of left ventricular hypertrophy, congestive heart failure, and stroke/TIA.
- Increased intraoperative cardiac events and AF-related postoperative complications were observed in the AF group.
- Six patients (19%) with paroxysmal AF developed chronic/persistent AF post-LT.
- Graft and patient survival rates were similar between groups.
Conclusions:
- Pre-existing AF in LT recipients is associated with increased intraoperative cardiac events and postoperative complications.
- Despite a more complex clinical course, AF does not adversely affect long-term graft or patient survival after LT.
- Careful perioperative management is crucial for LT patients with atrial fibrillation.
Abstract:
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it is associated with increased cardiovascular morbidity and all-cause mortality. Our aim was to determine the impact of preexisting AF on patients undergoing liver transplantation (LT). A retrospective case-control study was performed. Records from patients who underwent LT between January 2005 and December 2008 at Mayo Clinic Florida were reviewed. Patients with preexisting AF were identified and matched to patients who did not have a diagnosis of AF. Thirty-two of 717 LT recipients (4.5%) had AF before LT. These patients were compared to a control group of 63 LT recipients. Pre-LT left ventricular hypertrophy (P = 0.03), a history of congestive heart failure (P = 0.04), and a history of stroke or transient ischemic attack (P = 0.03) were significantly more prevalent in patients with AF versus controls. Intraoperative adverse cardiac events (P = 0.02) and AF-related adverse postoperative events (P < 0.001) were more common in the recipients with known AF. Six patients with paroxysmal AF (19%) developed chronic/persistent AF postoperatively. Graft survival and patient survival were similar in the groups. Although patients with AF had a higher incidence of intraoperative cardiac events, a higher cardiovascular morbidity rate, and a complicated postoperative course, this did not affect overall graft and patient survival.
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