Atrial fibrillation after lung transplantation: timing, risk factors, and treatment.

BACKGROUND: Atrial fibrillation (AF) is common after lung transplantation and can be challenging to manage. Objectives of this study were to determine prevalence and timing of perioperative AF, identify its risk factors, evaluate treatment strategies, assess return to sinus rhythm by hospital discharge, and investigate its impact on outcomes.

METHODS: From March 1995 to January 2005, 333 patients underwent primary lung transplantation (exclusive of heart and lung transplantation). Data on timing, prevalence, management, and outcome were extracted from the Unified Transplant Registry and Cardiothoracic Anesthesia databases, supplemented with medical record review. Risk factors for AF were identified by logistic regression analysis, and bootstrap bagging was used for variable selection.

RESULTS: AF developed postoperatively in 68 patients (20%), with the peak incidence 2 days after operation. Risk factors were older age (p = 0.0004), primary pulmonary hypertension (5 of 12 [42%] versus 63 of 321 [20%] for others, p = 0.006), and extremes of weight (p = 0.04). Pharmacologic treatment consisted of rate control agents only in 18 patients (27%), antiarrhythmics only in 5 (7.5%), and both in 44 (66%). Cardioversion was required in 24 (36%). Rhythm was recorded for 59 patients, and 55 (93%) were in sinus rhythm at discharge. Postoperative AF had no short-term or long-term survival impact.

CONCLUSIONS: AF after lung transplantation is common, with occurrence peaking 2 days postoperatively. Older patients and those with primary pulmonary hypertension are at elevated risk. Treatment requires a combination of multiple pharmacologic agents and electrical cardioversion. Almost all patients are discharged in sinus rhythm, and prognosis is unaffected.