Abstract 15634: Effect of Perioperative Atrial Fibrillation in Orthotopic Heart Transplant Recipients on Short and Long Term Mortality
Background: There has been considerable variance in the reported incidence of atrial fibrillation (AF) after orthotopic heart transplant (Htx). We sought to define the development of perioperative AF after OHTx at our center, possible risk factors for AF and its potential sequelae.
Methods: Pre-, intra-, and post-operative data of 864 consecutive adult OHTx patients between November 1998 and September 2010 were collected retrospectively. Patients were classified as AF or noAF by atrial fibrillation or flutter on 12 lead EKG within 30-days of surgery. Acute rejection events were defined as endomyocardial biopsy that exhibited ISHLT gradings of >2. Cardiac allograft vasculopathy was defined by ISHLT angiography criteria. Multivariate proportional hazards modeling occurred through stepwise reduction of pre- and intra- op variables with a threshold of p<0.1 and stratified by cardiopulmonary bypass time (CPBtime) due to non-proportional hazards.
Results: Incidence of perioperative AF was 9.38% (new onset: 38.3%), ventricular tachycardia 3.67%, and ventricular fibrillation 1.72%. Risk factors for perioperative AF include recipient age (p=0.01), donor age (p<0.01), female donor (p=0.02), donor toxoplasmosis (p<0.01), pre-op LVAD (p<0.01), CPBtime (p<0.01) as well as pre-operative AF (p <0.01). AF trended with increased 30-day mortality (p=0.07) and was associated with overall mortality (log-rank p=0.02). AF patients also had increased post-op VAD (p=0.01), pacemaker (0.01), respiratory failure (0.03), reoperation for bleeding (0.007), and stroke (0.015). AF was not significantly correlated to an increased number of year-1 rejection events (p=0.175), but was to the development of ISHLT CAV-2,3. (log-rank p =0.03). AF also proved to be an independent predictor for long-term mortality (p=0.06, 95% CI: 0.98-2.33).
Conclusions: AF is present in a significant portion of our OHTx in the post-operative period and correlates with a higher complication rate including stroke and higher mortality rate. These findings warrant further investigation into the etiology and prevention of AF and make a strong case for promptly initiating the treatment of AF in OHTx patients.
- Transplantation/medical aspects
- Atrial fibrillation
- Atrial flutter
- Transplantation/surgical aspects
- © 2011 by American Heart Association, Inc.