Atrial arrhythmias after lung transplantation: Incidence and risk factors in 652 lung transplant recipients

作者：D'Angelo Alex M; Chan Ernest G; Hayanga J W Awori; Odell David D; Pilewski Joseph; Crespo Maria; Morrell Matthew; Shigemura Norihisa; Luketich James; Bermudez Christian; Althouse Andrew D; D'Cunha Jonathan^*

来源：The Journal of Thoracic and Cardiovascular Surgery, 2016, 152(3): 901-909.

DOI：10.1016/j.jtcvs.2016.04.070

• atrial arrhythmias
• atrial fibrillation
• atrial flutter
• lung transplantation

Objectives: Atrial arrhythmia (AA) after lung transplantation (LTx) is a potentially morbid event often associated with increased length of hospital stay. Predictors of postsurgical AA, however, are incompletely understood. We characterized the incidence and predisposing risk factors for AA in patients undergoing LTx.
Methods: A retrospective analysis of prospectively collected data was conducted to identify LTx recipients between January 2008 and October 2013. Patients were divided into 2 groups on the basis of postoperative AA development. Univariable and multivariable analyses were performed to define differences between groups and identify factors associated with AA. Survival differences were assessed by the use of competing risks methodology.
Results: A total of 198 of 652 (30.4%) patients developed AA at a median onset of 5 days after transplant. Increasing age (hazard ratio [HR] 1.03 per additional year, P < .001) and previous coronary artery bypass grafting (HR 2.77, P = .002) were found to be independent risk factors. Counterintuitively, patients with a medical history of AA before LTx had a lower incidence of postoperative AA. Preoperative beta- blocker usage was not a significant predictor of postoperative AA. Postoperative AA was a significant predictor of long- term mortality (HR 1.63, P = .007) when we adjusted for other risk factors.
Conclusions: AA is a common occurrence after LTx, occurring with greatest frequency in the first postoperative week, and results in a significant reduction in long- term survival. Increasing age and before coronary artery bypass grafting were identified as independent risk factors for AA development. Better understanding of these risk factors may improve identification of patients at heightened risk after transplantation.

• 出版日期2016-9