Contemporary analysis of incidence of post-operative atrial fibrillation, its predictors, and association with clinical outcomes in lung transplantation

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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.

Original languageEnglish (US)
Pages (from-to)563-570
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Lung Transplantation
Atrial Fibrillation
Incidence
Length of Stay
Mortality
Logistic Models
Cardiopulmonary Bypass
Lung
Anti-Arrhythmia Agents
Mechanical Ventilators
Pulmonary Hypertension
Cardiac Arrhythmias
Therapeutics

Keywords

  • anti arrhythmics
  • atrial fibrillation
  • lung transplant
  • outcomes
  • predictors

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

@article{dad02945721c408cb429e23154c9f9a6,
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.",
keywords = "anti arrhythmics, atrial fibrillation, lung transplant, outcomes, predictors",
author = "Deepa Raghavan and Ang Gao and Chul Ahn and Fernando Torres and Manish Mohanka and Srinivas Bollineni and Matthias Peltz and Michael Wait and Steve Ring and Vaidehi Kaza",
year = "2015",
month = "4",
day = "1",
doi = "10.1016/j.healun.2014.09.032",
language = "English (US)",
volume = "34",
pages = "563--570",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "4",

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TY - JOUR

T1 - Contemporary analysis of incidence of post-operative atrial fibrillation, its predictors, and association with clinical outcomes in lung transplantation

AU - Raghavan, Deepa

AU - Gao, Ang

AU - Ahn, Chul

AU - Torres, Fernando

AU - Mohanka, Manish

AU - Bollineni, Srinivas

AU - Peltz, Matthias

AU - Wait, Michael

AU - Ring, Steve

AU - Kaza, Vaidehi

PY - 2015/4/1

Y1 - 2015/4/1

N2 - 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.

AB - 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.

KW - anti arrhythmics

KW - atrial fibrillation

KW - lung transplant

KW - outcomes

KW - predictors

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U2 - 10.1016/j.healun.2014.09.032

DO - 10.1016/j.healun.2014.09.032

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