title: Atrial arrhythmias after lung transplant: underlying mechanisms, risk factors, and prognosis.
abstract: BACKGROUND
  Atrial arrhythmias (AAs) early after lung transplant are frequent and have a significant impact on morbidity and mortality. However, the pathogenesis of AAs after lung transplant remains incompletely understood. In this study we aimed to determine the prevalence of atrial fibrillation (AF) and other AAs, as well as risk factors, clinical outcomes and possible underlying mechanisms associated with AAs after lung transplant.
  
  
  METHODS
  A retrospective analysis was performed on 382 patients who underwent lung transplantation from 2000 to 2010. A 12-lead electrocardiogram (ECG) was obtained and AAs classified as AF and other AAs (atrial flutter [AFL] and supraventricular tachycardia [SVT]). Multivariate logistic regression analysis was performed to determine predictors, and Kaplan-Meier survival curves were constructed.
  
  
  RESULTS
  The incidence of AAs was 25%; 17.8% developed AF and 7.6% other AAs (AFL/SVT). The major indication for transplant was idiopathic pulmonary fibrosis (IPF, 35%). Significant predictors of AF were as follows: age; IPF; left atrial enlargement; diastolic dysfunction; and history of coronary artery disease (CAD). Risk factors for other AAs (AFL/SVT) were: age; right ventricle dysfunction; right ventricular enlargement; and elevated right atrial pressure (RAP). One-year mortality was higher in the arrhythmia group (21.5% arrhythmia vs 15.7% no-arrhythmia group; p < 0.05). In addition, patients treated with anti-arrhythmic medications had higher mortality (p < 0.05).
  
  
  CONCLUSIONS
  AAs are common after lung transplantation. Risk factors for developing either AF or other AAs (AFL/SVT) are different. The development of early AAs post-transplant is associated with prolonged post-operative stay and increased mortality. A rate-control strategy should be used as first-line therapy and anti-arrhythmic agents reserved for those patients who do not respond to the initial treatment.
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA. Electronic address: corrego@houstonmethodist.org.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Orrego
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Cordero-Reyes
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Houston Methodist J.C. Walter Jr Transplant Center, Houston, Texas, USA.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Estep
authors.affiliation: Houston Methodist J.C. Walter Jr Transplant Center, Houston, Texas, USA.
authors.forename: Harish
authors.initials: H
authors.lastname: Seethamraju
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Houston Methodist J.C. Walter Jr Transplant Center, Houston, Texas, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Scheinin
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Houston Methodist J.C. Walter Jr Transplant Center, Houston, Texas, USA.
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Catedra de Cardiologia y Medicina Vascular, Tecnológico de Monterrey, Monterrey, Mexico.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D001282:Atrial Flutter / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality
keywords: arrhythmias; atrial fibrillation; atrial flutter; lung transplant; risk factors