Atrial fibrillation following lung transplantation: double but not single lung transplant is associated with long-term freedom from paroxysmal atrial fibrillation

European Heart Journal
Geoffrey LeePeter M Kistler

Abstract

The cornerstone of catheter ablation for atrial fibrillation (AF) is pulmonary vein electrical isolation (PVI). Recurrent AF post-PVI is a major limitation of the procedure with PV reconnection present in most patients. Single (SLT) and double (DLT) lung transplant surgery involves a 'cut and sew' PV antral isolation analogous to a catheter-based approach providing an opportunity to assess the efficacy of durable PVI. A total of three hundred and twenty-seven consecutive lung transplant patients were compared with 201 control non-transplant thoracic surgery (THR) patients between 1998 and 2008. The primary analysis was the incidence of 'early' post-operative AF and 'late' AF (AF occurring following discharge from hospital after the index operation). Risk factors for the development of late AF were analysed using regression analysis. Acute post-operative AF was more common post-lung transplant (DLT 58/200 (29%) and SLT 36/127 (28%) vs. THR 28/201 (13.9%), P < 0.001) occurring at 4.7 ± 5.0 days in DLT, 3.4 ± 2.5 days after SLT, and 7.4 ± 11.2 days in the thoracic group (P < 0.001). At a mean follow-up of 5.4 ± 2.9 years late AF occurred in 1/200 (0.5%) in DLT vs. 16/127 (12.6%) in SLT and 23/201 (11.4%, P < 0.001) in THR groups. ...Continue Reading

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