Contemporary analysis of incidence of post-operative atrial fibrillation, its predictors, and association with clinical outcomes in lung transplantation

Abstract

Background: Atrial fibrillation (AF) is a common complication after lung transplantation (LT). Since the lung allocation score (LAS) was implemented in 2005, there has been significant evolution in the practice of LT, necessitating re-evaluation of this arrhythmia.

Methods: One hundred thirty-one patients undergoing LT between January 2011 and April 2013 were reviewed retrospectively to assess the occurrence of AF and its outcomes (mortality, morbidity measures, treatment strategies). Uni- and multivariate logistic regression models were constructed to ascertain predictors of AF.

Results: Forty-six patients (35.1%) developed post-operative AF at 4.65 ± 3.68 days post-LT. The AF group was older (60.07 vs 54.48 years, p = 0.01), and had higher rates of cardiopulmonary bypass (CPB) (73.33% vs 43.53%, p = 0.001). There was no difference in mortality, ICU length of stay (LOS) and ventilator days; however, the AF group had a significantly higher mean hospital LOS by 8.43 days (17.09 vs 25.52, p = 0.04). Age (OR = 1.04, p = 0.03) and CPB (OR = 3.68, p = 0.002) were identified as predictors of AF by stepwise logistic regression after adjusting for gender, history of AF, type of LT, pulmonary hypertension and LT indication. In the AF group, 78.26% of patients required combination therapy. Anti-arrhythmics were used in 52.17% of patients. Dofetilide/ibutilide use was not associated with increased mortality. A total of 97.82% were in sinus rhythm at discharge.

Conclusions: To our knowledge, this is the first study to examine post-operative AF exclusively in the post-LAS era. Incidence of AF after LT is 35%. It increases hospital LOS, but not mortality. Management of AF is challenging and dofetilide/ibutilide serve as effective adjuncts to current therapy.

Keywords: anti arrhythmics; atrial fibrillation; lung transplant; outcomes; predictors.