title: Contemporary analysis of incidence of post-operative atrial fibrillation, its predictors, and association with clinical outcomes in lung transplantation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a common complication after lung transplantation (LT). Since the lung allocation score (LAS) was implemented in 2005, there has been significant evolution in the practice of LT, necessitating re-evaluation of this arrhythmia.
  
  
  METHODS
  One hundred thirty-one patients undergoing LT between January 2011 and April 2013 were reviewed retrospectively to assess the occurrence of AF and its outcomes (mortality, morbidity measures, treatment strategies). Uni- and multivariate logistic regression models were constructed to ascertain predictors of AF.
  
  
  RESULTS
  Forty-six patients (35.1%) developed post-operative AF at 4.65 ± 3.68 days post-LT. The AF group was older (60.07 vs 54.48 years, p = 0.01), and had higher rates of cardiopulmonary bypass (CPB) (73.33% vs 43.53%, p = 0.001). There was no difference in mortality, ICU length of stay (LOS) and ventilator days; however, the AF group had a significantly higher mean hospital LOS by 8.43 days (17.09 vs 25.52, p = 0.04). Age (OR = 1.04, p = 0.03) and CPB (OR = 3.68, p = 0.002) were identified as predictors of AF by stepwise logistic regression after adjusting for gender, history of AF, type of LT, pulmonary hypertension and LT indication. In the AF group, 78.26% of patients required combination therapy. Anti-arrhythmics were used in 52.17% of patients. Dofetilide/ibutilide use was not associated with increased mortality. A total of 97.82% were in sinus rhythm at discharge.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to examine post-operative AF exclusively in the post-LAS era. Incidence of AF after LT is 35%. It increases hospital LOS, but not mortality. Management of AF is challenging and dofetilide/ibutilide serve as effective adjuncts to current therapy.
authors.affiliation: Divisions of Pulmonary and Critical Care. Electronic address: dsr_19@yahoo.com.
authors.forename: Deepa
authors.initials: D
authors.lastname: Raghavan
authors.affiliation: Biostatistics.
authors.forename: Ang
authors.initials: A
authors.lastname: Gao
authors.affiliation: Biostatistics.
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Divisions of Pulmonary and Critical Care.
authors.forename: Fernando
authors.initials: F
authors.lastname: Torres
authors.affiliation: Divisions of Pulmonary and Critical Care.
authors.forename: Manish
authors.initials: M
authors.lastname: Mohanka
authors.affiliation: Divisions of Pulmonary and Critical Care.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Bollineni
authors.affiliation: Cardiothoracic Surgery, University of Texas Southwestern, Dallas, Texas.
authors.forename: Matthias
authors.initials: M
authors.lastname: Peltz
authors.affiliation: Cardiothoracic Surgery, University of Texas Southwestern, Dallas, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Wait
authors.affiliation: Cardiothoracic Surgery, University of Texas Southwestern, Dallas, Texas.
authors.forename: Steve
authors.initials: S
authors.lastname: Ring
authors.affiliation: Divisions of Pulmonary and Critical Care.
authors.forename: Vaidehi
authors.initials: V
authors.lastname: Kaza
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: anti arrhythmics; atrial fibrillation; lung transplant; outcomes; predictors