Arrhythmias and conduction disturbanceFrequency of Atrial Flutter After Adult Lung Transplantation
Section snippets
Methods
We retrospectively reviewed records of all patients undergoing lung transplantation at the University of California, San Francisco, from April 1998 through June 2010. Patients with uni- or bilateral lung transplantation were included in the study.
Patients' demographic and medical characteristics including age, gender, preoperation diagnosis, and date of transplantation were identified from their hospital records. A 12-lead electrocardiogram (ECG) was obtained before surgery. Patients underwent
Results
Two hundred sixty-nine patients 15 to 76 years of age who underwent lung transplantation were included for study. These patients were followed serially for the rest of their lives. Baseline characteristics of patients at time of transplantation are listed in Table 1. Preoperative echocardiograms of the study population revealed right ventricular hypertrophy in 59 (22%), right atrial enlargement in 78 (29%), and left atrial enlargement in 27 (10%). Eighty-two percent (n = 222) underwent
Discussion
Our study demonstrates that AFL and atypical AFL in particular are common after lung transplantation. Overall incidence of AFL in patients after lung transplantation was 13%, which is much higher than the rate in an age-matched population (rate 0.05).9 None of the patients in our cohort had previous AFL, suggesting that the transplantation procedure was responsible for the arrhythmia. Most of these diagnosed AFLs resolved without ablation.
Several studies have suggested that atrial arrhythmias
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Cited by (10)
Interpretation of Typical and Atypical Atrial Flutters by Precision Electrocardiology Based on Intracardiac Recording
2022, Cardiac Electrophysiology ClinicsCitation Excerpt :Surgical incisions will often provide a proarrhythmic substrate resulting in variable arrhythmia location, mechanism, and circuit. Postsurgical atrial arrhythmias have been observed for any procedure aimed directly at one or both atria, or when the atria serve only as an access portal as in lung31 and heart transplant.32 Spontaneous atrial scarring can also constitute an arrhythmic substrate and appears to have a predilection for specific RA and LA sites.33,34
Incidence, Predictors, and Outcomes of Early Atrial Arrhythmias After Lung Transplant: A Systematic Review and Meta-Analysis
2017, JACC: Clinical ElectrophysiologyCitation Excerpt :Additionally, there are anecdotal data on the benefit of statins and ranolazine for the prevention and management of post-cardiac surgery atrial fibrillation (43–46). Although the incidence of early post-lung transplant AAs is comparable to that after cardiac surgery, studies evaluating the best management strategies for early post-lung transplant AAs are lacking; therapeutic options for these patients have thus far been extrapolated from studies that addressed early AAs in post-CABG patients (7–10,14–17). In the present meta-analysis, we only included studies that reported atrial fibrillation and/or atrial flutter post-lung transplant, mainly because of the difference in pathophysiology and management of such AAs compared to other atrial tachyarrhythmia (e.g., atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, and atrial tachycardia).
Incidence, Risk factors, prognosis, and electrophysiological mechanisms of atrial arrhythmias after lung transplantation
2015, JACC: Clinical ElectrophysiologyCitation Excerpt :Our cumulative incidence of post-operative AA was also similar to other previous studies that reported a cumulative incidence of post-operative AA at 19% to 28% before hospital discharge (4,13–16), 39% within 14 days (3), and 34% by 4 weeks (5,16). In our study, the peak incidence of post-operative AA was at 5 days post-transplantation, which was consistent with the previous studies that reported the peak incidences of combined AA between 2 and 5 days after transplantation (3,4,15) but earlier than the peak incidence of pure AFL, which was between 10 and 12 days (17). In this study, we found invasive mPAP to be inversely associated with post-operative AA.
Atrial arrhythmias after lung transplant: Underlying mechanisms, risk factors, and prognosis
2014, Journal of Heart and Lung TransplantationCitation Excerpt :The higher incidence of AF in the Nielsen et al series may be explained, at least in part, by the large number of patients with AF before lung transplantation as well as the use of inotropes. The incidence of AFL in our cohort (5.7%) was much lower than that reported in two previous, both smaller studies by Gandhi et al6 (11.3% in a pediatric population) and Azadani et al9 (13% in adults). The reason for this significant difference is unclear, but we speculate that the use of calcium channel blockers or beta-blockers in about a third of our cohort of patients before transplant prevented the development of either AF or AFL.
Atrial tachyarrhythmias after lung transplantation in children: A common occurrence
2023, Pediatric TransplantationThe cardiovascular system in idiopathic pulmonary fibrosis
2020, ERS Monograph