Abstract 2511: Atrial Fibrillation Following Pulmonary Transplantation: Incidence, Treatment, and Short Term Outcomes
Background. Atrial fibrillation (AF) is a common complication following all types of major thoracic surgery, including lung transplantation. Lung transplant recipients however present fewer of the established risk factors for post operative AF. The incidence, the ideal therapeutic approaches and the in-hospital complications associated with AF in patients who undergo lung transplantation are largely unknown.
Methods. We retrospectively reviewed the medical files of 224 consecutive lung transplant recipients who underwent surgery between 05/1996 and 09/2006 at the Centre Hospitalier de l’Université de Montreal. The data collected included patient characteristics, treatment for AF and short term outcomes associated with postoperative AF.
Results. Mean age of recipients was 47 years, and the most frequent indication for transplantation was emphysema (37%). The mean pre-operative left ventricular ejection fraction was 65%. Only 12 patients (5.4%) had known CAD and 3 (1.3%) had a prior history of AF. Postoperative AF occurred in 65 patients (29%), a mean of 7.1 days after transplantation and lasted on average 3.1 days. Compared to patients without AF, mean length of stay was prolonged from 31 days to 52 days in patients with AF (p<0.01). Specific therapy for AF was administered to 96% of patients. Twenty-three (23) % of patients received up to 3 different anti-arrhythmic agents. IV amiodarone was used in 46% and calcium channel blockers in 40%. Electrical cardioversion was required in 28%, while IV heparin was used in 26% of patients. Stroke occurred in 1.5% of AF patients compared to 1.9% of patients without AF (p=NS). Only one patient remained in AF at discharge. No pulmonary complications could be clearly attributed to amiodarone.
Conclusion. In this large retrospective review, AF was fairly common following lung transplantation. Overall, complications were transient and benign and current pharmacological treatments appear effective. Despite an infrequent use of heparin, ischemic strokes were rare. Most patients returned to sinus rhythm before discharge.