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Long-term atrial arrhythmias incidence after heart transplantation
Matteo Anselmino1, Mario Matta2, Andrea Saglietto1
1Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Turin, Turin, Italy.
Insights
Atrial arrhythmias, including atrial fibrillation, are rare after heart transplantation. Echocardiographic, hemodynamic, and clinical factors may predict their occurrence in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Electrophysiology
Background:
- Atrial arrhythmias post-heart transplantation are infrequently studied.
- Understanding their incidence and predictors is crucial for long-term patient management.
Purpose of the Study:
- To determine the incidence and types of atrial arrhythmias in a large cohort of heart transplant recipients.
- To identify predictors of atrial arrhythmias during long-term follow-up.
Main Methods:
- A retrospective analysis of 364 heart transplant patients from 1990-2017.
- Systematic review of documented atrial arrhythmias (atrial fibrillation, flutter, tachycardias) during long-term follow-up.
- Univariate analysis of clinical, echocardiographic, and hemodynamic parameters.
Main Results:
- Persistent atrial arrhythmias occurred in 9.7% of patients (8 with flutter, 1 with AF).
- Paroxysmal sustained arrhythmias (atrial flutters) were detected in 11.5%.
- Predictors included specific echocardiographic, hemodynamic, and clinical factors.
Conclusions:
- Persistent atrial arrhythmias, particularly atrial fibrillation, are uncommon in heart transplant recipients.
- Surgical technique creating electrical isolation of the left atrium may prevent persistent AF.
Objectives:
Atrial arrhythmias after heart transplantation have rarely been investigated. The aim of this study is to assess incidence, type and predictors of atrial arrhythmias during a long-term follow-up in a large population of heart-transplanted patients.
Methods:
Consecutive patients undergone to heart transplantation at our Centre from 1990 to 2017 were enrolled. All documented atrial arrhythmias were systematically reviewed during a long-term follow-up after heart transplantation. Atrial fibrillation (AF), atrial flutter and tachycardias were defined according to current guidelines.
Results:
Overall, 364 patients were included and followed for 120 ± 70 months. During the follow-up period 108 (29.7%) patients died and 3 (0.8%) underwent re-transplantation. Sinus rhythm was present in 355 (97.5%) patients. Nine patients had persistent atrial arrhythmias: 8 (2.2%) presented atypical flutter and one (0.3%) patient AF. Paroxysmal sustained arrhythmias were detected in 42 (11.5%) patients, always atrial flutters. At univariate analysis several echocardiographic (left ventricular end-diastolic diameter, TEI index, mitral and tricuspid regurgitation grade) hemodynamic (systolic and diastolic pulmonary pressure, capillary wedge pressure) and clinical (dyslipidaemia, weight, pacemaker implantation) parameters related to higher incidence of atrial arrhythmias.
Conclusion:
Persistent atrial arrhythmias, and most of all AF, are rare among heart transplantation carriers, despite substantial comorbidities resulting in significant mortality. It can be speculated that the lesion set provided by the surgical technique, a complete and transmural electrical isolation of the posterior left atrium wall, represents an effective lesion set to prevent persistent AF.
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