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Original Articles

Atrial Arrhythmias After Lung Transplantation

Epidemiology, Mechanisms at Electrophysiology Study, and Outcomes

Vincent Y. See, MD; Kurt C. Roberts-Thomson, MBBS, PhD; William G. Stevenson, MD; Phillip C. Camp, MD and Bruce A. Koplan, MD

From the Cardiac Arrhythmia Service, Cardiovascular Division, Department of Medicine (V.Y.S., K.C.R.-T., W.G.S., B.A.K.), and the Division of Thoracic Surgery, Department of Surgery (P.C.C.), Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Bruce A. Koplan, MD, Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail bkoplan{at}partners.org

Received March 24, 2009; accepted August 5, 2009.

Background— Atrial arrhythmias (AAs) including atrial fibrillation (AF) and atrial tachycardia (AT) are often observed after cardiothoracic surgery. Our aim was to evaluate the prevalence and mechanism of AAs after lung transplantation.

Methods and Results— All patients (n=127) after bilateral sequential lung transplantation followed at our institution over 20 years were included. All patients received postoperative rhythm monitoring and clinic visits with ECG at 1, 3, 6, and 12 months, or as needed. AAs occurred in 40 of 127 (31.5%) patients over 4.2±4.1 years. AA prevalence at postoperation and 1, 3, 6, 12, and >12 months was 24%, 11%, 3%, 2%, 4%, and 11%, respectively. Early AAs were predominantly AF, whereas all AAs >12 months were AT. Time to first AF versus AT was 11±9 versus 1485±2462 days (P=0.09). Male sex, age, and preoperative AA predicted any early (<3 months) AA but did not predict late AA. Early AA did not predict late AT. In 4 patients with drug-resistant AT, electrophysiology studies found AT involving the pulmonary vein/left atrium anastomoses in 3 patients, including donor-to-recipient conduction in 1, border zone macroreentry in 2, and cavotricuspid isthmus dependent flutter in 1; all patients were successfully treated with ablation.

Conclusions— AAs after lung transplantation are common. Although AF is common early, AF is rare after healing of left atrial incisions, which probably result in surgical pulmonary vein isolation with rare exception. This raises the question of whether additional surgical or ablation lines at the time of lung transplantation would prevent late AA.

Key Words: catheter ablation • tachyarrhythmia • transplant • lung • fibrillation

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CLINICAL PERSPECTIVE

Guest editor for this article was Michael E. Cain, MD.