PURPOSE:To evaluate the origin, incidence, predisposing factors, and impact of arrhythmias following lung transplantation.
METHODS:Retrospective chart analysis of all lung transplant recipients in 2006 and 2007 was done. The following data were collected: Demographics, cardiopulmonary bypass time, ischemic time, use of vasopressors, onset of arrhythmia, type of arrhythmia,electro physiological analysis, and treatment (chemical cardioversion or electrical cardioversion or electro physiological ablation).
RESULTS:A total of 75 patients underwent lung transplant during this time period. Seventeen underwent single and 58 underwent double lung transplant. The incidence of arrhythmias within 30 days in this cohort was 38%. Most common arrhythmia was atrial fibrillation (50% of all arrhythmias), followed by atrial flutter (30%). There was no statistically significant difference between the variables assessed comparing patients with and without arrhythmic events (figure.1) except the age of the patient. Electro physiologic (EP) study was done in 5 patients for recurrent or refractory arrhythmias. Three EP studies were done in patients greater than 5 months post transplant. In one patient, the origin of atrial flutter was in the left superior pulmonary vein of donor origin (figure 2). In another patient, there were 2 reentrant circuits around the origin of left pulmonary veins (donor origin). Another patient had left atrial origin of atrial flutter. The other 2 patients had AV nodal reentrant tachycardia. All the above 5 patients underwent electro physiological ablation.
CONCLUSION:Atrial tachyarrhythmias occur in a significant percentage of patients post lung transplantation. Contrary to the prior studies published by Nielson et al (Chest 2004;126;496–500), donor derived tissue (atrial cuff or the pulmonary vein) is a likely arrhythmogenic focus which can propagate to the recipient heart despite complete surgical pulmonary vein isolation due to entrapped myofibrobasts at the suture line.
CLINICAL IMPLICATIONS:EP study may be needed to evaluate and treat refractory arrhythmias occurring post lung transplantation. Donor atrial or pulmonary vein can be a potential arrythmogenic focus and better surgical techniques to isolate donor tissue are warranted.
DISCLOSURE:Goutham Dronavalli, No Financial Disclosure Information; No Product/Research Disclosure Information