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Marazzato J, Eikermann M, Di Biase L. Management of Atrial Arrhythmias After Lung Transplant. JACC Clin Electrophysiol 2023; 9:1824-1835. [PMID: 37648342 DOI: 10.1016/j.jacep.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/21/2022] [Accepted: 01/18/2023] [Indexed: 09/01/2023]
Abstract
The overall survival in patients undergoing lung transplantation is poor. Although postsurgical atrial arrhythmias seem to play a major role in the morbidity and mortality of this population, data regarding the clinical and interventional management of this complication are still controversial. Through a review of the literature in the field, we observed that not only the surgical technique is clearly arrhythmogenic, but the new administration of peri-procedure beta-blockers and amiodarone for arrhythmia prevention and treatment, respectively, seems harmful in these postsurgical patients. However, low-dose beta-blockers administered after surgery seem feasible in arrhythmia prevention in specific patient subgroups, and, aside from amiodarone, alternative antiarrhythmic agents can be safely and effectively used to treat symptomatic patients on top of adequate rate control. Finally, as to complex atrial arrhythmias occurring late after lung transplant surgery, radiofrequency catheter ablation seems a feasible treatment option. In light of this evidence and considering the absence of clear recommendations in the field, we suggest a practical approach that may help the clinician in the management of this postsurgical complication. However, as most of these considerations are drawn from small-sized and retrospective studies, more evidence is needed in the future to clarify which medical and interventional strategies may best treat these postsurgical arrhythmias and thus potentially improve the outcome of these frail patients.
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Affiliation(s)
- Jacopo Marazzato
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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2
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Kao CC, Wang T, Parulekar AD. Need for anticoagulation and use of direct oral anticoagulants in lung transplant recipients. J Thromb Thrombolysis 2021; 52:232-238. [PMID: 33661478 DOI: 10.1007/s11239-021-02399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
Limited information is available about use of direct oral anticoagulants (DOACs) in lung transplant recipients (LTRs). The purpose of this study is to describe the indications and use of long-term anticoagulation, including the safety and tolerability of DOACs, in LTRs. This was a single-center retrospective study. LTRs who received therapeutic anticoagulation were identified. Patient characteristics, indications for treatment, and complications of therapy were obtained. A total of 203 patients underwent lung transplantation of which 118 patients (58.1%) had an indication for anticoagulation. Patients with an indication for anticoagulation were older than those without (59 ± 14 years versus 48 ± 17 years, p < 0.001) and were more likely to be male (72.0% versus 50.6%, p = 0.002). Of the patients with indication for anticoagulation, 74 (62.7%) received it. Fifty-one (68.9%) of patients receiving anticoagulation were treated with DOACs. In the patients receiving anticoagulation, there were 14 major bleeding events in 13 patients, of which 3 were receiving DOACs and the remainder were receiving heparin or warfarin. The need for anticoagulation is common in LTRs for both atrial arrhythmias and venous thromboembolism. However, many patients with atrial arrhythmias do not receive anticoagulation. The use of DOACs is well tolerated and safe in LTRs.
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Affiliation(s)
- Christina C Kao
- Section of Pulmonary, Critical Care, and Sleep, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Tai Wang
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amit D Parulekar
- Section of Pulmonary, Critical Care, and Sleep, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. .,Vanderbilt University Medical Center, 1161 21st Ave South, T1218 MCN, Nashville, TN, 37232, USA.
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3
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McIntyre WF, Vadakken ME, Rai AS, Thach T, Syed W, Um KJ, Ibrahim O, Dalmia S, Bhatnagar A, Mendoza PA, Benz AP, Bangdiwala SI, Spence J, McClure GR, Huynh JT, Zhang T, Inami T, Conen D, Devereaux PJ, Whitlock RP, Healey JS, Belley-Côté EP. Incidence and recurrence of new-onset atrial fibrillation detected during hospitalization for non-cardiac surgery: a systematic review and meta-analysis. Can J Anaesth 2021; 68:1045-1056. [PMID: 33624255 DOI: 10.1007/s12630-021-01944-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE This systematic review aimed to summarize reports of the incidence and long-term recurrence of new-onset atrial fibrillation (AF) associated with non-cardiac surgery. SOURCES We searched CENTRAL, MEDLINE and EMBASE from inception to November 2019. We included studies that reported on the incidence of new-onset perioperative AF during hospitalization for non-cardiac surgery and/or AF recurrence in such patients following discharge. Reviewers screened articles and abstracted data independently and in duplicate. We assessed study quality by appraising methodology for collecting AF history, incident AF during hospitalization, and AF recurrence after discharge. PRINCIPAL FINDINGS From 39,233 citations screened, 346 studies that enrolled a total of 5,829,758 patients met eligibility criteria. Only 27 studies used prospective, continuous inpatient electrocardiographic (ECG) monitoring to detect incident AF. Overall, the incidence of postoperative AF during hospitalization ranged from 0.004 to 50.3%, with a median [interquartile range] of 8.7 [3.8-15.0]%. Atrial fibrillation incidence varied with type of surgery. Prospective studies using continuous ECG monitoring reported significantly higher incidences of AF than those that did not (13.9% vs 1.9%, respectively; P < 0.001). A total of 13 studies (25,726 patients) with follow-up up to 5.4 years reported on AF recurrence following hospital discharge; only one study used a prospective systematic monitoring protocol. Recurrence rates ranged from 0 to 37.3%. CONCLUSIONS Rates of AF incidence first detected following non-cardiac surgery and long-term AF recurrence vary markedly. Differences in the intensity of ECG monitoring and type of surgery may account for this variation. TRIAL REGISTRATION PROSPERO (CRD42017068055); registered 1 September 2017.
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Affiliation(s)
- William F McIntyre
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| | - Maria E Vadakken
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Anand S Rai
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Terry Thach
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Wajahat Syed
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kevin J Um
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Omar Ibrahim
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shreyash Dalmia
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Akash Bhatnagar
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Pablo A Mendoza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alexander P Benz
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jessica Spence
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Graham R McClure
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jessica T Huynh
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tianyi Zhang
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Toru Inami
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - P J Devereaux
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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4
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Gong J, Wang X, Liu Z, Yao S, Xiao Z, Zhang M, Zhang Z. Risk factors and survival analysis of arrhythmia following lung cancer surgery: a retrospective study. J Thorac Dis 2021; 13:847-860. [PMID: 33717558 PMCID: PMC7947489 DOI: 10.21037/jtd-20-2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Surgical treatment of lung cancer is one of the important treatments for early-stage non-small cell lung cancer (NSCLC). However, arrhythmia, especially atrial fibrillation (AF) and supraventricular arrhythmia, are quite common among patients after surgical treatment of lung cancer. The impact of postoperative arrhythmia (PA) on survival is rarely reported. Our aim was to evaluate the risk factors of PA and its impact on overall survival (OS) after lung cancer surgery. Methods A total of 344 patients diagnosed with NSCLC who underwent lung cancer surgery were enrolled in this study. These patients were divided into two groups based on the occurrence of PA. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors of PA. The Kaplan-Meier method was applied to show the OS differences between the two groups. Results The incidence of PA was 16% (55/344). Among these 55 patients, 20 had AF, 30 had sinus tachycardia, and 5 had premature beats. A total of 332 patients underwent lung cancer radical resection. Operation type (P<0.001), preoperative abnormal ECG (P=0.032), transfusion (P=0.016), postoperative serum potassium concentration (P=0.001) and clinical stage (P<0.05) were risk factors for PA. PA (HR 2.083, 95% CI, 1.334–3.253; P=0.001), age (HR 1.543, 95% CI, 1.063–2.239; P=0.025) and mediastinal lymph node metastasis (HR 2.655, 95% CI, 1.809–3.897; P<0.001) were independent prognostic risk factors for OS by multivariate cox analysis. Conclusions We identified PA as an independent prognostic risk factor to predict poor OS in patients who underwent lung cancer surgery and had risk factors for PA. We therefore provides guidance for PA in improving the prognosis of lung cancer patients.
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Affiliation(s)
- Jialin Gong
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiaofei Wang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zuo Liu
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Shuang Yao
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zengtuan Xiao
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Mengzhe Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhenfa Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Mariani MV, Pothineni NVK, Arkles J, Deo R, Frankel D, Supple G, Garcia F, Lin D, Hyman MC, Kumareswaran R, Riley M, Nazarian S, Schaller RD, Epstein AE, Bermudez C, Dixit S, Callans D, Marchlinski FE, Santangeli P. Catheter ablation of atrial arrhythmias following lung transplant: Electrophysiological findings and outcomes. J Cardiovasc Electrophysiol 2020; 32:49-57. [PMID: 33205513 DOI: 10.1111/jce.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/20/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Data on the mechanisms of atrial arrhythmias (AAs) and outcomes of catheter ablation (CA) in lung transplantation (LT) patients are insufficient. We evaluated the electrophysiologic features and outcomes of CA of AAs in LT patients. METHODS AND RESULTS: We conducted a retrospective study of all the LT patients who underwent CA for AAs at our institution between 2004 and 2019. A total of 15 patients (43% males, age: 61 ± 10 years) with a history of LT (60% bilateral and 40% unilateral) were identified. All patients had documented organized AA on surface electrocardiogram and seven patients also had atrial fibrillation (AF; 47% with >1 clinical arrhythmia). At electrophysiological study, 19 organized AAs were documented (48% focal and 52% macro-re-entrant). Focal atrial tachycardias/flutters were targeted along the pulmonary vein (PV) anastomotic site at the left inferior PV (n = 2), ridge and carina of the left superior PV (n = 2), left atrium (LA) posterior wall (n = 3), LA roof (n = 1), and tricuspid annulus (n = 1). Macro-re-entrant AAs included cavotricuspid isthmus-dependent flutter (n = 2), incisional LA flutter (n = 4), LA roof-dependent flutter (n = 1), and mitral annular flutter (n = 3). In patients with LA mapping (n = 13), PV reconnection on the side of the LT was found in six patients (40%, all with clinically documented AF), with a mean of 2.1 ± 0.9 PVs reconnected per patient. Patients with AF underwent successful PV isolation. After a median follow-up of 19 months (range: 6-86 months), 75% of patients remained free from recurrent AAs. No procedural major complications occurred. CONCLUSION In patients with prior LT, recurrent AAs are typically associated with substrate surrounding the surgical anastomotic lines and/or chronically reconnected PVs. CA of AAs in this population is safe and effective to achieve long-term arrhythmia control.
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Affiliation(s)
- Marco V Mariani
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Arkles
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rajat Deo
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Frankel
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory Supple
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Lin
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew C Hyman
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramanan Kumareswaran
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Riley
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert D Schaller
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew E Epstein
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian Bermudez
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Callans
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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6
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Saglietto A, Matta M, Gaita F, De Ferrari GM, Anselmino M. Late atrial arrhythmias after lung transplantation: a meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 21:577-582. [PMID: 32618761 DOI: 10.2459/jcm.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Atrial arrhythmias are common following noncardiac thoracic surgery. In particular, early postoperative atrial arrhythmias after lung transplantation are very frequent, especially atrial fibrillation (AFib). Late atrial arrhythmia occurrence following lung transplantation, instead, has been less commonly reported. METHODS The aim of the present systematic review and meta-analysis is to analyse the incidence rate of late atrial arrhythmia and AFib in lung transplantation patients, with a special focus on double lung transplant (DLT), also to assess potential predictors of AFib occurrence. After bibliographic search (PUBMED/Medline and Embase databases), a random-effect model meta-analysis was performed: seven studies were finally included, including 2068 lung transplantation patients. RESULTS The pooled incidence rate of late atrial arrhythmia was 4.3%/year [95% confidence interval (CI) 2.8-6.1%/year, I = 69%], whereas late AFib incidence rate was 1.5%/year (95% CI 0.7-2.6%/year, I = 87%). In patients undergoing DLT, the pooled incidence rate of late atrial arrhythmia was 4.1%/year (95% CI 2.5-6.0%/year, I = 67%), while the AFib incidence rate was 0.9%/year (95% CI 0.1-2.4%/year, I = 92%). A longer follow-up duration significantly related to the reduced incidence rate of AFib (P = 0.02). History of AFib (hazard ratio 11.2, 95% CI 5.9-21.3) and early postoperative AFib (hazard ratio 10.3, 95% CI 5.9-18.0) emerged, instead, as relevant predictors of AFib occurrence. CONCLUSION Late atrial arrhythmia occurrence is not infrequent in lung transplantation patients; however, late Afib incidence was rare and showed a time-dependent decrease, particularly in DLT patients, suggesting that a transmural pulmonary veins isolation, the mainstay of transcatheter ablation, is effective in decreasing the likelihood of experiencing AFib.
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Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin
| | - Mario Matta
- Division of Cardiology, Sant'Andrea Hospital, Vercelli
| | - Fiorenzo Gaita
- Cardiovascular Department, Clinica Pinna Pintor, Policlinico di Monza, Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin
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7
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Barnes H, Gurry G, McGiffin D, Westall G, Levin K, Paraskeva M, Whitford H, Williams T, Snell G. Atrial Flutter and Fibrillation Following Lung Transplantation: Incidence, Associations and a Suggested Therapeutic Algorithm. Heart Lung Circ 2019; 29:1484-1492. [PMID: 31786113 DOI: 10.1016/j.hlc.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/25/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Atrial arrhythmias are relatively common following lung transplantation and confer considerable perioperative risk, specifically haemodynamic instability, pulmonary congestion, dyspnoea, and can mask other post-transplant complications such as infection or acute rejection. However, for most patients, arrhythmias are limited to the short-term perioperative period. METHODS We present a retrospective case-control analysis of 200 lung transplant recipients and using multivariate regression analysis, document the present incidence, risk factors, and outcomes between the two groups. RESULTS Twenty-five per cent (25%) of lung transplantation patients developed atrial flutter or fibrillation, most frequently at day 5-7 post lung transplantation, and more commonly present in older recipients and those with underlying chronic obstructive pulmonary disease (COPD), but not in those with previously noted structural heart disease, or in those undergoing single rather than double lung transplants. Atrial arrhythmias were associated with increased intensive care unit and overall length of stay, but were not associated with increased risk of in-hospital stroke, or mortality. Based on our experience, we propose a suggested management algorithm for pharmacological and mechanical rate/rhythm control strategies, for anticoagulation, and discuss the appropriate duration of treatment. CONCLUSIONS Atrial arrhythmias are relatively common post lung transplantation. Carefully managed, the associated risk of perioperative morbidity and mortality can be mitigated. Further prospective studies are required to validate these strategies.
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Affiliation(s)
- Hayley Barnes
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia.
| | - Greta Gurry
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery and Transplantation Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Glen Westall
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Kovi Levin
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Miranda Paraskeva
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Helen Whitford
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Trevor Williams
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Greg Snell
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
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Xie K, Zhang W, Fang J, Guo Y, Fang M, Ding Z, Hu Y, Yu W, Li F. Prevalence and risk factors of atrial fibrillation during lung and esophageal surgery: A Prospective observational study. Medicine (Baltimore) 2018; 97:e11549. [PMID: 30045278 PMCID: PMC6078744 DOI: 10.1097/md.0000000000011549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this prospective observational study was to screen for risk factors of intraoperative atrial fibrillation (AF) during noncardiac thoracic surgery. The study was conducted as a single-institution study in Zhejiang Cancer Hospital, Hangzhou, China. All the participants were patients with cancer scheduled for thoracotomy.This study was conducted from July 2013 to August 2016 and included 144 patients scheduled for thoracotomy under general anesthesia. We collected the patients' demographic and perioperative medical data in our hospital. AF was diagnosed using electrocardiography (ECG), on the basis of the presence of characteristic ECG features of AF by one or more ECG leads for at least 30 seconds.Of the participants, 144 completed the study and 18 developed intraoperative AF. Higher percentages of subjects in the AF group than in the non-AF group had histories of chemotherapy (P = .014) and alcohol consumption (P = .034) before surgery. The AF group had a lower mean body mass index (P = .019), significantly higher mean heart rate (P < .001), and lower tidal volume (P = .01) than the non-AF group. After the logistic regression analysis, only alcohol consumption (odds ratio [OR] = 5.279; 95% confidence interval [CI]: 1.432-19.467), history of chemotherapy (OR = 4.019; 95% CI: 1.504-15.334), and high heart rate (OR = 1.093; 95% CI: 1.033-1.156) during 1-lung ventilation were identified as the risk factors of AF during lung and esophageal surgeries.The incidence of intraoperative AF during noncardiac thoracic surgery was 12.5%. Alcohol consumption, history of chemotherapy, and high heart rate during 1-lung ventilation were the risk factors related to intraoperative AF.
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Affiliation(s)
- Kangjie Xie
- The Third Affiliated Hospital of Soochow University, Changzhou
- Department of Anesthesiology
| | | | | | - Ye Guo
- Department of Anesthesiology
| | | | | | - Yuqian Hu
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou
| | - Weifeng Yu
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Shanghai
| | - Fugui Li
- Department of Anesthesiology, Qinghai Provincial People's Hospital, Xining, China
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9
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Uhm JS, Park MS, Joung B, Pak HN, Paik HC, Lee MH. Intra-atrial reentrant tachycardia originating from the pulmonary vein cuff anastomosis in a lung transplantation patient: Ultra-high-density 3-dimensional mapping. HeartRhythm Case Rep 2018; 4:152-154. [PMID: 29755944 PMCID: PMC5944044 DOI: 10.1016/j.hrcr.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jae-Sun Uhm
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Moo Suk Park
- Division of Pulmonology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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10
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Roukoz H, Benditt DG. Atrial arrhythmias after lung transplantation. Trends Cardiovasc Med 2017; 28:53-61. [PMID: 28797718 DOI: 10.1016/j.tcm.2017.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
Atrial arrhythmias are a common complication after lung transplant (LT), occurring in about 16-46% of LT patients early postoperatively, and in about 14% during longer-term follow-up. They have a significant impact on postoperative in-hospital length of stay and may have an impact on overall mortality. In this report, we review the incidence and risk factors of post lung transplant AA, their pathogenesis and their impact on short- and long-term outcomes. Pharmacological management options are reviewed. In brief, early atrial arrhythmias tend to be mostly atrial fibrillation and are treated acutely with a rate control strategy followed if needed by rhythm control for 4-6 weeks. Late atrial arrhythmias >6 months after LT tend to be more frequently organized atrial flutters amenable to ablation therapy. Long-term anticoagulation is controversial especially in patients with bilateral lung transplant who received surgical pulmonic vein isolation, however anticoagulation is still favored especially in single LT patients. More studies are needed to further document the pathophysiology of early versus late atrial arrhythmias and whether long-term anticoagulation is needed.
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Affiliation(s)
- Henri Roukoz
- Cardiology Division, Electrophysiology Section, University of Minnesota, Minneapolis, MN.
| | - David G Benditt
- Cardiology Division, Electrophysiology Section, University of Minnesota, Minneapolis, MN
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Atrial Fibrillation and Pulmonary Venous Electrical Conduction Recovery After Full Surgical Resection and Anastomosis of the Pulmonary Veins. JACC Clin Electrophysiol 2017; 3:559-567. [DOI: 10.1016/j.jacep.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 11/23/2022]
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12
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Waldron NH, Klinger RY, Hartwig MG, Snyder LD, Daubert JP, Mathew JP. Adverse outcomes associated with postoperative atrial arrhythmias after lung transplantation: A meta-analysis and systematic review of the literature. Clin Transplant 2017; 31. [PMID: 28181294 DOI: 10.1111/ctr.12926] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Postoperative atrial arrhythmias (AAs) are common after lung transplantation, but studies are mixed regarding their impact on outcomes. We therefore performed this systematic review and meta-analysis to determine whether AAs after lung transplantation impede postoperative recovery. METHODS MEDLINE, EMBASE, CINAHL, and the Cochrane Register were searched to identify studies comparing outcomes in adult patients undergoing lung transplantation who experienced postoperative AAs in the immediate postoperative period vs those without postoperative AAs. Our primary outcome was perioperative mortality, and secondary outcomes were length of stay (LOS), postoperative complications, and mid-term (1-6 years) mortality. RESULTS Nine studies including 2653 patients were included in this analysis. Of this group, 791 (29.8%) had postoperative AAs. Patients with postoperative AAs had significantly higher perioperative (OR 2.70 [95% CI: 1.73-4.19], P<.0001) mortality, longer hospital LOS (MD 8.29 [95% CI: 4.37-12.21] days, P<.0001), more frequent requirement for tracheostomy (OR 4.67 [95% CI: 2.59-8.44], P<.0001), and higher mid-term mortality (OR 1.71 [95% CI: 1.28-2.30], P=.0003). CONCLUSIONS AAs after lung transplantation are frequent and associated with significantly higher mortality, longer hospital LOS, and requirement for tracheostomy. Given their impact on recovery, prophylactic strategies against AAs need to be developed.
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Affiliation(s)
| | | | | | | | | | - Joseph P Mathew
- Department of Anesthesiology, Duke University, Durham, NC, USA
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13
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Saad M, Elgendy IY, Mentias A, Abdelaziz HK, Barakat AF, Abuzaid A, Elgendy AY, Mojadidi MK, Chandrashekaran S, Mahmoud AN. Incidence, Predictors, and Outcomes of Early Atrial Arrhythmias After Lung Transplant: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol 2017; 3:718-726. [PMID: 29759540 DOI: 10.1016/j.jacep.2016.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/18/2016] [Accepted: 12/08/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study sought to determine the incidence, predictors, and prognostic implications of early post-lung transplant atrial arrhythmias (AAs). BACKGROUND Although frequently encountered, the prognostic implications of early AAs after lung transplant remain uncertain. METHODS A systematic review of MEDLINE and the Cochrane Library was conducted for all studies that reported early post-lung transplant AAs. Random-effects DerSimonian-Laird risk ratios (RRs) were calculated for categorical variables and standardized mean difference (SMD) for continuous variables. RESULTS A total of 12 studies with 3,203 patients (mean age 57 ± 3 years; 52% males) were included. The incidence of early post-lung transplant AAs during hospitalization was 26.6% at mean follow-up duration of 6.7 days. Predictors of post-lung transplant AAs included advanced age (SMD: 0.50; 95% confidence interval [CI]: 0.35 to 0.64), male gender (RR: 1.37; 95% CI: 1.28 to 1.47), history of smoking (RR: 1.23; 95% CI: 1.05 to 1.46), hypertension (RR: 1.35; 95% CI: 1.13 to 1.59), hyperlipidemia (RR: 1.39; 95% CI: 1.18 to 1.63), coronary artery disease (RR: 1.40; 95% CI: 1.12 to 1.7), left atrial diameter (SMD: 0.25; 95% CI: 0.07 to 0.44), and restrictive lung disease (RR: 1.34; 95% CI: 1.13 to 1.59). Post-lung transplant AAs were associated with increased all-cause mortality (adjusted RR: 1.63; 95% CI: 1.22 to 2.19) at mean follow-up of 27.8 months and length of hospital stay (36.5 ± 16.5 days vs. 26.1 ± 14.3 days; p < 0.001). CONCLUSIONS Early AAs post-lung transplant are associated with increased mortality and length of hospital stay. Advanced age, male sex, smoking, hypertension, hyperlipidemia, coronary artery disease, increased left atrial diameter, and restrictive lung disease are independent predictors of early AAs in post-lung transplant patients.
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Affiliation(s)
- Marwan Saad
- Department of Medicine, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Islam Y Elgendy
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Amgad Mentias
- Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Hesham K Abdelaziz
- Department of Cardiovascular Medicine, Blackpool Teaching Hospital NHS Foundation Trust, Lancashire Cardiac Centre, Blackpool, United Kingdom
| | - Amr F Barakat
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmed Abuzaid
- Department of Medicine, Division of Cardiology, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Delaware
| | - Akram Y Elgendy
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Mohammad K Mojadidi
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Satish Chandrashekaran
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida
| | - Ahmed N Mahmoud
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
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14
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Jesel L, Barraud J, Lim HS, Marzak H, Messas N, Hirschi S, Santelmo N, Olland A, Falcoz PE, Massard G, Kindo M, Ohlmann P, Chauvin M, Morel O, Kessler R. Early and Late Atrial Arrhythmias After Lung Transplantation ― Incidence, Predictive Factors and Impact on Mortality ―. Circ J 2017; 81:660-667. [DOI: 10.1253/circj.cj-16-0892] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Laurence Jesel
- Department of Cardiology, University Hospital of Strasbourg
| | | | - Han S. Lim
- Department of Cardiology, Austin and Northern Health
| | - Halim Marzak
- Department of Cardiology, University Hospital of Strasbourg
| | - Nathan Messas
- Department of Cardiology, University Hospital of Strasbourg
| | | | - Nicola Santelmo
- Department of Thoracic Surgery, University Hospital of Strasbourg
| | - Anne Olland
- Department of Thoracic Surgery, University Hospital of Strasbourg
| | | | - Gilbert Massard
- Department of Thoracic Surgery, University Hospital of Strasbourg
| | - Michel Kindo
- Department of Cardiology, University Hospital of Strasbourg
| | | | - Michel Chauvin
- Department of Cardiology, University Hospital of Strasbourg
| | - Olivier Morel
- Department of Cardiology, University Hospital of Strasbourg
| | - Romain Kessler
- Department of Pneumology, University Hospital of Strasbourg
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15
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Sadek MM, Maeda S, Chik W, Santangeli P, Zado ES, Schaller RD, Supple GE, Frankel DS, Hutchinson MD, Garcia FC, Riley MP, Lin D, Dixit S, Callans DJ, Marchlinski FE. Recurrent atrial arrhythmias in the setting of chronic pulmonary vein isolation. Heart Rhythm 2016; 13:2174-2180. [DOI: 10.1016/j.hrthm.2016.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Indexed: 10/21/2022]
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16
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Magruder JT, Plum W, Crawford TC, Grimm JC, Borja MC, Berger RD, Tandri H, Calkins H, Cameron DE, Mandal K. Incidence of late atrial fibrillation in bilateral lung versus heart transplants. Asian Cardiovasc Thorac Ann 2016; 24:772-778. [PMID: 27634822 DOI: 10.1177/0218492316669272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We compared the incidence of late-onset atrial fibrillation in orthotopic heart transplant recipients and bilateral orthotopic lung transplant recipients. METHODS We reviewed the records of all heart and lung transplant operations carried out in our institution between 1995 and 2015. We performed 1:1 propensity-matching based on patient age, sex, body mass index, and hypertension. Our primary outcome, late-onset atrial fibrillation, was defined as atrial fibrillation occurring after discharge following hospitalization for transplantation. RESULTS Over the study period, 397 orthotopic heart transplants and 240 bilateral orthotopic lung transplants were performed. Propensity matching resulted in 173 pairs who were matched with respect to age, sex, body mass index, and preoperative hypertension. The median follow-up was 5.3 years for heart transplant patients and 3.1 years for lung transplant patients. Late-onset atrial fibrillation occurred in 11 heart transplant patients (5 of whom had biopsy-proven evidence of rejection) and 19 lung transplant patients (2 of whom had biopsy-proven evidence of rejection). On Kaplan-Meier analysis, the probability of late-onset atrial fibrillation at 5 years was 4.3% for heart transplant patients vs. 13.9% for lung transplant patients (log-rank p = 0.01). CONCLUSIONS We documented an increased probability of late-onset atrial fibrillation among bilateral orthotopic lung transplant patients compared to orthotopic heart transplant patients. This was a hypothesis-generating study that suggests a potential role for cardiac autonomic innervation in the genesis of atrial fibrillation.
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Affiliation(s)
- J Trent Magruder
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - William Plum
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Todd C Crawford
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Joshua C Grimm
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Marvin C Borja
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Ronald D Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Kaushik Mandal
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA
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17
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Evaluation of Enoxaparin Dosing as a Risk Factor for Bleeding in Lung Transplant Recipients. Ann Pharmacother 2016; 50:824-31. [DOI: 10.1177/1060028016656434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Lung transplant recipients commonly develop complications that lead to anticoagulation. Standard FDA-approved enoxaparin dosing in this population results in a high incidence of above-goal anti-Xa levels, but its association with bleeding remains unclear. Objective: To evaluate the association between enoxaparin dosing and bleeding in lung transplant recipients and assess the relationship between dosing and anti-Xa levels. Methods: We conducted a single-center retrospective cohort study of adult lung transplant recipients who received therapeutic enoxaparin between 2000 and 2012 at a tertiary academic center. We dichotomized enoxaparin dosing regimens into standard dose (FDA-approved doses with a 10% rounding margin) and reduced dose. Clinicians ordered anti-Xa levels as deemed clinically appropriate. The primary outcome was major bleeding or clinically relevant nonmajor bleeding. Results: Of 222 patients treated with enoxaparin, 33 (14.9%) had bleeding events, of which half (17/33) were major. Bleeding occurred in 25/146 (17.1%) patients who received standard-dose enoxaparin versus 8/76 (10.5%) patients who received reduced-dose enoxaparin ( P = 0.190). Multiple logistic regression demonstrated an independent association between standard-dose enoxaparin and bleeding, after adjusting for confounders (adjusted odds ratio = 3.04; 95% CI = 1.14-8.10). The median enoxaparin dose in patients with above-goal versus at-goal anti-Xa levels was 0.89 versus 0.76 mg/kg every 12 hours; P = 0.006. However, doses yielding at-goal anti-Xa levels had an interquartile range of 0.67 to 0.90 mg/kg, which overlapped with doses yielding above- and below-goal anti-Xa levels. Conclusions: Enoxaparin dose reduction and anti-Xa level monitoring can improve drug safety and facilitate individualized dose optimization in lung transplant recipients.
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D'Angelo AM, Chan EG, Hayanga JWA, Odell DD, Pilewski J, Crespo M, Morrell M, Shigemura N, Luketich J, Bermudez C, Althouse AD, D'Cunha J. Atrial arrhythmias after lung transplantation: Incidence and risk factors in 652 lung transplant recipients. J Thorac Cardiovasc Surg 2016; 152:901-9. [PMID: 27234020 DOI: 10.1016/j.jtcvs.2016.04.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 03/25/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Alex M D'Angelo
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - J W Awori Hayanga
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - David D Odell
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Joseph Pilewski
- Department of Pulmonary Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Maria Crespo
- Department of Pulmonary Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Matthew Morrell
- Department of Pulmonary Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Norihisa Shigemura
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - James Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Christian Bermudez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Andrew D Althouse
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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19
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Sanam K, Holmes D, Shah D, Foster N. Late atrial tachycardia originating from donor pulmonary vein in a double lung transplant recipient. HeartRhythm Case Rep 2015; 1:490-493. [PMID: 28491613 PMCID: PMC5419732 DOI: 10.1016/j.hrcr.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kumar Sanam
- St John Providence Medical Center, Southfield, Michigan
| | | | - Dipak Shah
- St John Providence Medical Center, Southfield, Michigan
| | - Nathan Foster
- St John Providence Medical Center, Southfield, Michigan
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20
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Chaikriangkrai K, Jyothula S, Jhun HY, Chang SM, Graviss EA, Shuraih M, Rami TG, Dave AS, Valderrábano M. Incidence, Risk Factors, Prognosis, and Electrophysiological Mechanisms of Atrial Arrhythmias after Lung Transplantation. JACC Clin Electrophysiol 2015; 1:296-305. [PMID: 26557726 DOI: 10.1016/j.jacep.2015.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate incidence and timing, risk factors, prognostic significance, and electrophysiological mechanisms of atrial arrhythmia (AA) after lung transplantation. BACKGROUND Although new-onset AA is common after thoracic surgery and is associated with poorer outcomes, prognostic and mechanistic data is sparse in lung transplant populations. METHOD A total of 293 consecutive isolated lung transplant recipients without known AA were retrospectively reviewed. Mean follow-up was 28±17 months. Electrophysiology studies (EPS) were performed in 25 patients with AA. RESULTS The highest incidence of new-onset AA after lung transplantation occurred within 30 days postoperative AA, (25 % of all patients). In multivariable analysis, postoperative AA was associated with double lung transplantation (OR 2.79; p=0.005) and lower mean pulmonary artery pressure (OR 0.95; p=0.027). Patients with postoperative AA had longer hospital stays (21 days vs 12 days; p<0.001). Postoperative AA was independently associated with late AA (HR 13.52; p<0.001) but not mortality (HR 1.55; p=0.14). In EPS, there were 14 patients with atrial flutter alone and 11 with atrial flutter and fibrillation. Of all EPS patients, 20 (80%) had multiple AA mechanisms, including peritricuspid flutter (48%), perimitral flutter (36%), right atrial incisional reentry (24%), focal tachycardia from recipient pulmonary vein (PV) antrum (32 %), focal PV fibrillation (24%), and left atrial roof flutter (20%). Left atrial mechanisms were present in 80% (20/25) of EPS patients and originated from the anastomotic PV antrum. CONCLUSIONS Postoperative AA was independently associated with longer length of stay and late AA but not mortality. Pleomorphic PV antral arrhythmogenesis from native PV antrum is the main cause of AA after lung transplantation.
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Affiliation(s)
| | - Soma Jyothula
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA ; Methodist J.C. Walter Jr. Transplant Center; Houston Methodist Hospital, Houston, TX, USA
| | - Hye Yeon Jhun
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Su Min Chang
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Edward A Graviss
- Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Mossaab Shuraih
- Texas Heart Institute/St. Luke's Episcopal Hospital, Houston, TX, USA
| | - Tapan G Rami
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Amish S Dave
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Miguel Valderrábano
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
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21
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Budev MM, Yun JJ. Medical complications after lung transplantation. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Raghavan D, Gao A, Ahn C, Torres F, Mohanka M, Bollineni S, Peltz M, Wait M, Ring S, Kaza V. Contemporary analysis of incidence of post-operative atrial fibrillation, its predictors, and association with clinical outcomes in lung transplantation. J Heart Lung Transplant 2015; 34:563-70. [DOI: 10.1016/j.healun.2014.09.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/08/2014] [Accepted: 09/19/2014] [Indexed: 11/17/2022] Open
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23
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Lin D, Santangeli P, Zado ES, Bala R, Hutchinson MD, Riley MP, Frankel DS, Garcia F, Dixit S, Callans DJ, Marchlinski FE. Electrophysiologic findings and long-term outcomes in patients undergoing third or more catheter ablation procedures for atrial fibrillation. J Cardiovasc Electrophysiol 2015; 26:371-377. [PMID: 25534677 DOI: 10.1111/jce.12603] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/30/2014] [Accepted: 12/18/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Pulmonary vein (PV) status, arrhythmia sources, and outcomes with ≥3 ablation procedures have not been characterized. METHODS AND RESULTS All patients with ≥3 procedures were included and underwent antral reisolation of reconnected PVs and ablation of non-PV triggers. Of 2,886 patients who underwent PVI, 181 (6%) had more than 2 ablation procedures (3 procedures in 146 and ≥4 procedures in 35). In 12 patients, the clinical arrhythmia was other than AF. Of the remaining 169 patients, 69 (41%) had 4 reconnected PVs, 27 (16%) had 3, 31 (18%) had 2, and 29 (17%) had 1. Only 13 (8%) had all PVs still isolated. Provocative techniques in 127 patients initiated PV triggers in 92 patients, including AF or PV atrial tachycardia in 64 (50%), and reproducible PV APDs in 28 (22%). Thirty-six (20%) had a new non-PV trigger targeted. At a mean of 36 months (12-119 months) after last procedure, 63 patients (47%) had no AF off antiarrhythmic drugs (AAD); 28 (21%) had no AF with AAD; and 18 (13%) had rare AF with good symptom control; 26 patients (19%) had recurrent AF. CONCLUSIONS At time of third or greater AF ablation, PV reconnection is the rule (92%) and PV triggers initiating AF can be demonstrated. Following repeat PVI and targeting non-PV triggers, 81% of patients had clinical AF control. Our findings suggest that PV reisolation and attempts to identify and eliminate non-PV triggers are effective and support the role of multiple repeat procedures for AF recurrence.
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Affiliation(s)
- David Lin
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica S Zado
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rupa Bala
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew D Hutchinson
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael P Riley
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, Calkins H, Aranki S, Kaneko T, Cassivi S, Smith SC, Darbar D, Wee JO, Waddell TK, Amar D, Adler D. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg 2014; 148:e153-93. [PMID: 25129609 PMCID: PMC4454633 DOI: 10.1016/j.jtcvs.2014.06.036] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Gyorgy Frendl
- Department of Anesthesiology, Perioperative Critical Care and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Alissa C Sodickson
- Department of Anesthesiology, Perioperative Critical Care and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Mina K Chung
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Molecular Cardiology, Lerner Research Institute Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University Cleveland Clinic, Cleveland, Ohio
| | - Albert L Waldo
- Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Bernard J Gersh
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn
| | - James E Tisdale
- Department of Pharmacy Practice, College of Pharmacy, Purdue University and Indiana University School of Medicine, Indianapolis, Ind
| | - Hugh Calkins
- Department of Medicine, Cardiac Arrhythmia Service, Johns Hopkins University, Baltimore, Md
| | - Sary Aranki
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Stephen Cassivi
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Sidney C Smith
- Center for Heart and Vascular Care, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Dawood Darbar
- Division of Cardiovascular Medicine, Department of Medicine, Arrhythmia Service, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Jon O Wee
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Thomas K Waddell
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Amar
- Memorial Sloan-Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, NY
| | - Dale Adler
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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25
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2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. Executive summary. J Thorac Cardiovasc Surg 2014; 148:772-91. [DOI: 10.1016/j.jtcvs.2014.06.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 11/23/2022]
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Atrial arrhythmias after lung transplant: Underlying mechanisms, risk factors, and prognosis. J Heart Lung Transplant 2014; 33:734-40. [DOI: 10.1016/j.healun.2014.02.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 01/30/2014] [Accepted: 02/13/2014] [Indexed: 11/23/2022] Open
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The inconvenient truth of elevated left atrial pressure and AF recurrence despite catheter ablation. Heart Rhythm 2014; 11:961-2. [PMID: 24681114 DOI: 10.1016/j.hrthm.2014.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Indexed: 11/20/2022]
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Has the Time Come to Abandon the Concept That “Pulmonary Vein Isolation Is the Cornerstone of Atrial Fibrillation Ablation”? Circ Arrhythm Electrophysiol 2013; 6:241-2. [DOI: 10.1161/circep.113.000377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Noheria A, Patel SM, Mirzoyev S, Madhavan M, Friedman PA, Packer DL, Daly RC, Kushwaha SS, Edwards BS, Asirvatham SJ. Decreased postoperative atrial fibrillation following cardiac transplantation: the significance of autonomic denervation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:741-7. [PMID: 23437907 DOI: 10.1111/pace.12102] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 11/15/2012] [Accepted: 12/06/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endocardial ablation approaches targeting the retroatrial cardiac ganglia to treat atrial fibrillation (AF) have been proposed. However, the potential value using this approach is unknown. Disruption of the autonomic inputs with orthotropic heart transplant (OHT) provides a unique opportunity to study the effects of autonomic innervation on AF genesis and maintenance. We hypothesized that due to denervation, the risk of postoperative AF would be lower following OHT compared to surgical maze even though both groups get isolation of the pulmonary veins. METHODS AND RESULTS We reviewed 155 OHTs (mean age 52 ± 11 years, 72% males) and used 1:1 age-, sex-, and date-of-surgery-matched two control groups from patients undergoing surgical maze or only coronary artery bypass grafting (CABG). Using conditional logistic regression we compared the odds of AF within 2 weeks following OHT versus controls. Postoperative AF occurred in 10/155 (6.5%) OHT patients. The conditional odds of postoperative AF were lower for OHT as compared to controls (vs maze: odds ratio [OR] 0.27 [95% confidence interval (CI) 0.13-0.57], vs CABG: OR 0.38 [0.17-0.81], P = 0.003; and on additional adjustment for left atrial enlargement, vs maze: OR 0.28 [0.13-0.60], vs CABG: OR 0.14 [0.04-0.47], P = 0.0009). CONCLUSIONS Risk of postoperative AF is significantly lower with OHT as in comparison to surgical maze. As both surgeries entail isolation of the pulmonary veins but only OHT causes disruption of autonomic innervation, this observation supports a mechanistic role of autonomic nervous system in AF. The benefit of targeting the cardiac autonomic system to treat AF needs further investigation.
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Affiliation(s)
- Amit Noheria
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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The association between pulmonary hypertension and lower risk of postoperative atrial fibrillation after lung transplantation. J Electrocardiol 2013; 46:43-4. [PMID: 23312360 DOI: 10.1016/j.jelectrocard.2012.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Indexed: 11/24/2022]
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2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
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Elsik M, Teh A, Ling LH, Virdee M, Parameshwar J, Fynn SP, Kistler PM. Supraventricular arrhythmias late after orthotopic cardiac transplantation: electrocardiographic and electrophysiological characterization and radiofrequency ablation. Europace 2012; 14:1498-505. [PMID: 22523376 DOI: 10.1093/europace/eus092] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiac transplantation (CTX) is an effective treatment for end-stage heart disease. Cardiac arrhythmias are increasingly recognized and associated with significant morbidity and mortality. We aim to describe the clinical and electrophysiological characteristics of patients with atrial arrhythmias occurring late after CTX. METHODS AND RESULTS Sixteen patients with prior CTX who presented with late atrial arrhythmias for electrophysiological studies (EPS) were identified at two cardiac transplant centres. Among 859 patients, 16 (mean age 52 ± 14 years, 11 of 16 were men) patients underwent EPS for atrial arrhythmias presenting 8.6 ± 5.7 years following CTX. Among 16 patients, 14 underwent cardiac alone and 2 included lung transplantation. There were no cases of cardiac rejection. Arrhythmias were due to counterclockwise cavotricuspid-dependent atrial flutter (AFL) in 10 of 16, atrial tachycardia (AT) in 6 (1 patient had AFL and AT), and 1 due to atrioventricular nodal re-entrant tachycardia. Recipient-donor atrial electrical connection was seen in two of six AT and in no cases of AFL. In two cases, a focal AT was mapped to the remnant atrium conducting 2 : 1 or at variable block to the donor atrium. In four cases a focal/micro re-entrant AT originated within the vicinity of the interatrial suture scar. All cases were successfully ablated with radiofrequency energy; however, one case of AFL required a repeat ablation. Patients remained free of arrhythmia at 34 ± 15 months post-ablation. CONCLUSION Typical AFL and AT are the most frequent supraventricular arrhythmias occurring late following CTX. Focal ATs may originate in low-voltage or border zones immediately adjacent to the atrio-atrial anastomosis. Radiofrequency ablation is an effective treatment strategy with high long-term success.
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Affiliation(s)
- Maros Elsik
- Department of Cardiology, Papworth Hospital NHS Trust, Cambridge, UK
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14:528-606. [PMID: 22389422 DOI: 10.1093/europace/eus027] [Citation(s) in RCA: 1141] [Impact Index Per Article: 95.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 2012; 9:632-696.e21. [PMID: 22386883 DOI: 10.1016/j.hrthm.2011.12.016] [Citation(s) in RCA: 1299] [Impact Index Per Article: 108.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Indexed: 12/20/2022]
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Henri C, Giraldeau G, Dorais M, Cloutier AS, Girard F, Noiseux N, Ferraro P, Rinfret S. Atrial fibrillation after pulmonary transplantation: incidence, impact on mortality, treatment effectiveness, and risk factors. Circ Arrhythm Electrophysiol 2011; 5:61-7. [PMID: 22157520 DOI: 10.1161/circep.111.964569] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common after thoracic surgery. Limited data exist concerning the incidence of AF, its impact on mortality, the effectiveness of therapy, and the risk factors of AF after pulmonary transplantation. METHODS AND RESULTS We reviewed the medical files of 224 consecutive lung transplant recipients who underwent surgery over a 10-year period at a large Canadian center. We collected patient characteristics, in-hospital treatments, and outcomes. Time-to-event analysis was used to account for in-hospital follow-up and models generated to assess the impact of AF on mortality and independent risk factors of AF after transplantation. Postoperative AF occurred in 65 patients (29%). AF was more likely to occur with complications such as pneumonia, mediastinitis, and bronchial dehiscence and was not an independent risk factor of mortality (hazard ratio=1.56; 95% confidence interval, 0.52-4.63). Pharmacological or electric therapy for rhythm or rate control of AF was administered to 97% of patients. Intravenous amiodarone was used in 46%, electric cardioversion in 28%, and heparin in 26%. Only 1 patient remained in AF at discharge. Age (hazard ratio=1.08 by year; 95% confidence interval, 1.05-1.12), bilateral transplantation (hazard ratio=1.87; 95% confidence interval, 1.03-3.42), and a history of AF before the transplantation (hazard ratio=4.48; 95% confidence interval, 1.05-19.11) were found to be independently associated with an increased incidence of postoperative AF. CONCLUSIONS AF is fairly common after pulmonary transplantation, transient, and relatively benign. It is not independently associated with increased in-hospital mortality. Most patients return to sinus rhythm before discharge. Age, prior AF, and bilateral transplantation increase the risk of postoperative AF.
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Affiliation(s)
- Christine Henri
- Adult Cardiology Program, University of Montreal, Montreal, Canada
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Garcia S, Canoniero M, Sattiraju S, Chen LY, Adkisson W, Hertz M, Benditt DG. Atrial Fibrillation After Lung Transplantation: Incidence, Predictors and Long-Term Implications. J Atr Fibrillation 2011; 4:363. [PMID: 28496701 DOI: 10.4022/jafib.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/18/2011] [Accepted: 07/14/2011] [Indexed: 11/10/2022]
Abstract
Background: Little is known about the frequency of, risk factors predisposing to, and long-term impact of post-operative atrial fibrillation (AF) after lung transplantation. Methods: A prospectively collected registry of 167 consecutive patients who underwent single or bilateral lung transplantation at the University of Minnesota Medical Center from January 1st, 2004 to December 30th, 2008 was reviewed. Post-operative AF was confirmed by review of electrocardiograms by two cardiologists. Kaplan-Meier survival curves were constructed to determine the impact of new onset AF on long-term survival. Results: The mean age (±SD) of the population was 55 ± 11 years and 52% were male. A total of 48 patients (28%) developed AF in the postoperative period. Predictors of postoperative AF in multivariate analysis included: age (per decade) Odds Ratio (OR): 1.61, 95% confidence interval (CI) 1.10-2.34, p=0.01, postoperative thromboembolic disease OR: 9.73 (95% CI: 2.16-43.81, p<0.01, and postoperative pericarditis OR: 3.57, (95% CI: 1.38-9.22, p < 0.01). Of the 48 patients who developed post-operative AF, 41 were discharged in sinus rhythm (SR). Survival among patients who were discharged in AF was significantly lower when compared to patients discharged in SR (HR: 0.08; 0.01-0.43, p<0.05). Conclusions: Postoperative AF is common after lung transplant. Increased age, postoperative thromboembolic disease, and pericarditis are independent predictors of postoperative AF. Persistence of AF at the time of discharge is an identifier of decreased survival.
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Affiliation(s)
- Santiago Garcia
- University of Minnesota, Department of Medicine, Division of Cardiovascular Medicine. Minneapolis, MN.,Minneapolis VA Medical Center. Minneapolis, MN
| | - Mariana Canoniero
- University of Minnesota, Department of Medicine, Division of Cardiovascular Medicine. Minneapolis, MN
| | - Srinivasan Sattiraju
- University of Minnesota, Department of Medicine, Division of Cardiovascular Medicine. Minneapolis, MN
| | - Lin Y Chen
- University of Minnesota, Department of Medicine, Division of Cardiovascular Medicine. Minneapolis, MN
| | - Wayne Adkisson
- University of Minnesota, Department of Medicine, Division of Cardiovascular Medicine. Minneapolis, MN
| | - Marshall Hertz
- University of Minnesota, Department of Medicine, Division of Pulmonary and Critical Care Medicine. Minneapolis, MN
| | - David G Benditt
- University of Minnesota, Department of Medicine, Division of Cardiovascular Medicine. Minneapolis, MN
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Advances in imaging for atrial fibrillation ablation. Radiol Res Pract 2011; 2011:714864. [PMID: 22091384 PMCID: PMC3200077 DOI: 10.1155/2011/714864] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 12/30/2010] [Indexed: 01/13/2023] Open
Abstract
Over the last fifteen years, our understanding of the pathophysiology of atrial fibrillation (AF) has paved the way for ablation to be utilized as an effective treatment option. With the aim of gaining more detailed anatomical representation, advances have been made using various imaging modalities, both before and during the ablation procedure, in planning and execution. Options have flourished from procedural fluoroscopy, electroanatomic mapping systems, preprocedural computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and combinations of these technologies. Exciting work is underway in an effort to allow the electrophysiologist to assess scar formation in real time. One advantage would be to lessen the learning curve for what are very complex procedures. The hope of these developments is to improve the likelihood of a successful ablation procedure and to allow more patients access to this treatment.
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Cabrera JA, Pizarro G, Sánchez-Quintana D. Transmural ablation of all the pulmonary veins: is it the Holy Grail for cure of atrial fibrillation? Eur Heart J 2010; 31:2708-11. [PMID: 20819904 DOI: 10.1093/eurheartj/ehq241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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