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Published on: February 26, 2013
Atrial fibrillation before heart transplantation is a risk factor for post-transplant atrial fibrillation and
Fabrice F Darche1,2,3, Matthias Helmschrott1,3, Ann-Kathrin Rahm1,2,3
1Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.
Insights
Atrial fibrillation before heart transplantation (HTX) significantly increases the risk of developing AF after HTX. This condition is linked to higher mortality, stroke, and pacemaker implantation rates post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Clinical Outcomes Research
Background:
- Atrial fibrillation (AF) post-heart transplantation (HTX) is linked to adverse clinical outcomes.
- Understanding pre-transplant AF as a predictor of post-transplant AF is crucial for patient management.
Purpose of the Study:
- To investigate the association between pre-existing atrial fibrillation (AF) and the occurrence of AF within 30 days following heart transplantation (HTX).
Main Methods:
- A cohort of 639 adult heart transplant recipients was analyzed.
- Patients were categorized based on AF status before and after HTX.
- Data included recipient/donor factors, medications, echocardiographic findings, pacemaker implantation, stroke, and mortality.
Main Results:
- Patients with AF both before and after HTX exhibited significantly higher 1-year mortality (39.7%) compared to those without AF (18.1%).
- Pre-transplant AF was associated with enlarged atria, ventricular dysfunction, mitral regurgitation, and increased rates of stroke and pacemaker implantation.
- Multivariate analysis identified pre-transplant AF as a strong predictor (HR 6.59) of post-transplant AF, with donor age and ischemic time also being risk factors.
Conclusions:
- Atrial fibrillation prior to heart transplantation is a significant risk factor for developing AF post-transplant.
- Pre-transplant AF is also associated with increased risks of permanent pacemaker implantation and mortality after HTX.
Aims:
Atrial fibrillation (AF) after heart transplantation (HTX) is associated with worse clinical outcomes. The current study aimed to analyse the association between AF before HTX and AF within 30 days after HTX.
Methods And Results:
This study included 639 adults who received HTX at Heidelberg Heart Center. Patients were subdivided into four groups depending on the status of AF before and after HTX. Analyses comprised recipient and donor data, medication, echocardiographic features, permanent pacemaker implantation, stroke, and mortality after HTX. Three hundred thirty-two patients (52.0%) had neither AF before nor after HTX, 15 patients (2.3%) had no AF before HTX but showed AF after HTX, 219 patients (34.3%) showed AF before HTX but had no AF after HTX, and 73 patients (11.4%) had AF before and after HTX. Patients with AF before and after HTX had a higher 1 year post-transplant mortality (39.7%) than patients without AF before or after HTX (18.1%, P < 0.01). Secondary outcomes showed a higher percentage of enlarged atria, ventricular dysfunction, mitral regurgitation, 1-year stroke, and 1-year permanent pacemaker implantation in patients with AF before and after HTX. Multivariate analysis revealed a six-fold elevated risk for post-transplant AF in patients with AF before HTX (hazard ratio: 6.59, confidence interval: 3.72-11.65; P < 0.01). Further risk factors for post-transplant AF were higher donor age and prolonged ischaemic time, whereas total orthotopic HTX was associated with a two-fold lower risk for post-transplant AF.
Conclusions:
Atrial fibrillation before HTX is a risk factor for post-transplant AF, permanent pacemaker implantation, and mortality after HTX.
