Published Online
on August 25, 2009

A more recent version of this article appeared on October 1, 2009

This Article Full Text (PDF) All Versions of this Article: 2/5/504    most recent CIRCEP.109.867978v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by See, V. Y. Articles by Koplan, B. A. PubMed PubMed Citation Articles by See, V. Y. Articles by Koplan, B. A. Related Collections Arrhythmias, clinical electrophysiology, drugs Ablation/ICD/surgery CV surgery: transplantation, ventricular assistance, cardiomyopathy Electrophysiology

Original Article

Atrial Arrhythmias following Lung Transplantation: Epidemiology, Mechanisms at Electrophysiology Study, and Outcomes

Vincent Y. See; Kurt C. Roberts-Thomson; William G. Stevenson; Phillip C. Camp, Jr. and Bruce A. Koplan¹

Brigham and Women's Hospital, Boston, MA

^* Corresponding author; email: bkoplan{at}partners.org

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

Methods & Results—All patients (127 (pts)) post bilateral sequential LT followed at our institution over 20 years were included. All pts received post-operative rhythm monitoring and clinic visit with ECG at 1, 3, 6, 12 mos, or as needed. AA occurred in 40/127 (31.5%) pts over 4.2 ± 4.1 yrs. AA prevalence at post-op, 1, 3, 6, 12 and >12mo was 24%, 11%, 3%, 2%, 4% and 11%, respectively. Early AA were predominantly AF, while all AA >12mo were AT. Time to 1^st AF vs. AT was 11 ± 9 vs. 1485 ± 2462 days (p=0.09). Male gender, age and pre-operative AA predicted any early (<3mo) AA but did not predict late AA. Early AA did not predict late AT. In 4 pts with drug resistant AT, electrophysiology studies found AT involving the PV/LA anastomoses in three pts including donor to recipient conduction in one, border zone macroreentry in two, and cavotricuspid isthmus dependent flutter in one; all pts were successfully treated with ablation.

Conclusion—AA following LT are common. Although AF is common early, AF is rare following healing of LA incisions which likely result in surgical pulmonary vein isolation with rare exception. This raises the question of whether additional surgical or ablation lines at the time of LT would prevent late AA.

Key Words: catheter ablation • fibrillation • lung • tachyarrhythmias • transplantation