SESSION TITLE: Arrhythmia Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Post-operative atrial fibrillation (AF) is a common complication after lung transplantation (LT). With implementation of the Lung Allocation Score (LAS) in 2005, increasing LT recipients have older age, diagnosis of pulmonary fibrosis, higher acuity and bilateral LT; all of which have been previously identified as risk factors for AF. Hence, we aimed to reassess the current incidence of AF, its predictors and outcomes.
METHODS: In a retrospective cohort analysis, electronic medical records of 131 patients receiving LT between 01/2011 and 04/2013 were examined to determine occurrence of AF (defined as AF prior to discharge or within 30 days of lung transplantation, whichever was earlier) and its outcomes (mortality, morbidity measures, treatment strategies). Characteristics of AF and non AF group were compared. Logistic regression models were constructed to ascertain predictors of AF.
RESULTS: 46 patients (35.1%) developed post operative AF at 4.65±3.68 days post LT. AF group was older (60.07 vs 54.48 years, p 0.01) and had higher proportion of bilateral LT (91.3% vs 83.5%, p<0.05) and cardiopulmonary bypass (73.33% vs 43.53%, p 0.001). There was no difference in mortality, ICU length of stay (LOS) and ventilator days, however, AF group had significantly higher mean hospital LOS by 8.43 days (17.09 vs 25.52, p 0.04). In the AF group, 78.26% required combination therapy, rate control agents were used in 86.96%, anti-arrhythmics in 52.17% and electrical cardioversion in 34.78%. 45 of 46 patients were in sinus rhythm at discharge. Age and cardiopulmonary bypass were identified as predictors of AF by multivariate logistic regression.
CONCLUSIONS: To our knowledge, this is the first study looking at incidence of post operative AF in the post LAS era. Occurrence of AF after LT is 35%. It increases hospital LOS, but not mortality. Management of AF in this population is challenging and frequently requires combination therapy.
CLINICAL IMPLICATIONS: With exponential increase in LT, this high prevalence of AF and increased LOS translates into escalating health care resource utilization. Future studies assessing preventive measures are greatly needed.
DISCLOSURE: The following authors have nothing to disclose: Deepa Raghavan, Fernando Torres, Manish Mohanka, Srinivas Bollineni, Vaidehi Kaza
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