title: Incidence of atrial fibrillation in heart transplant patients: long-term follow-up.
abstract: BACKGROUND
  The incidence of atrial fibrillation (AF) in heart transplant patients has not been well documented.
  
  
  METHODS
  To determine the incidence of AF in a cohort of patients undergoing cardiac transplantation, clinical data were obtained from a prospectively collected database for all consecutive orthotopic heart transplantation (OHT) patients and for all consecutive coronary artery bypass graft (CABG) surgery patients between January 1984 and March 2004 at our institution. A cohort of 1,714 OHT patients and low-risk CABG (normal ejection fraction [EF] and no left ventricular hypertrophy [LVH]) patients were age- and sex-matched.
  
  
  RESULTS
  The average age in the two groups was 56 +/- 7 years with 87% male and 81% white race and body mass index (BMI) of 26 +/- 4. There were 3 cases of AF (0.3%) in the OHT group and 757 cases of AF (21%) in the low-risk CABG group. The strongest independent predictor of freedom from postoperative AF was having had a transplant (odds ratio [OR] 96, 95% confidence interval [CI] 13-720). The incidence of AF, atrial flutter (AFL), and supraventricular tachycardia (SVT) in OHT was 0.33, 2.8%, and 1.3%, respectively. Given that incidence of AF, AFL, and SVT in historical post-CABG population is 25%, 17%, and 4.3%, transplanted patients appear to have lower incidence of AF, AFL, and SVT than the reference population. Consistent with this, transplanted patients underwent few ablation procedures for atrial arrhythmias. Additionally, the three patients with AF had bicaval anastomoses suggesting the possibility of PACs originating in the donor superior vena cava (SVC) or IVC (inferior vena cava) initiating AF in these patients.
  
  
  CONCLUSIONS
  In a cohort study of transplant and low-risk CABG patients, the strongest independent predictor of freedom from AF is having undergone transplant surgery. One potential explanation for the markedly lower incidence of AF may be effective isolation of thoracic veins with documented cases retaining the native SVC.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khan
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Kalahasti
authors.forename: Vivek
authors.initials: V
authors.lastname: Rajagopal
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: Soufian
authors.initials: S
authors.lastname: Almahameed
authors.forename: Ryan
authors.initials: R
authors.lastname: Zuzek
authors.forename: Tehmeena
authors.initials: T
authors.lastname: Shah
authors.forename: Dhanumjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cummings
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D017115:Catheter Ablation; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013617:Tachycardia, Supraventricular / Q000453:epidemiology