Incidence , Predictors , and Outcomes of Early Atrial Arrhythmias After Lung Transplant

Fro Ar of Ca Kin Ca an Flo Ma OBJECTIVES This study sought to determine the incidence, predictors, and prognostic implications of early post-lung transplant atrial arrhythmias (AAs). BACKGROUND Although frequently encountered, the prognostic implications of early AAs after lung transplant remain uncertain. METHODS A systematic review of MEDLINE and the Cochrane Library was conducted for all studies that reported early post-lung transplant AAs. Random-effects DerSimonian-Laird risk ratios (RRs) were calculated for categorical variables and standardized mean difference (SMD) for continuous variables. RESULTS A total of 12 studies with 3,203 patients (mean age 57 3 years; 52% males) were included. The incidence of early post-lung transplant AAs during hospitalization was 26.6% at mean follow-up duration of 6.7 days. Predictors of post-lung transplant AAs included advanced age (SMD: 0.50; 95% confidence interval [CI]: 0.35 to 0.64), male gender (RR: 1.37; 95% CI: 1.28 to 1.47), history of smoking (RR: 1.23; 95% CI: 1.05 to 1.46), hypertension (RR: 1.35; 95% CI: 1.13 to 1.59), hyperlipidemia (RR: 1.39; 95% CI: 1.18 to 1.63), coronary artery disease (RR: 1.40; 95% CI: 1.12 to 1.7), left atrial diameter (SMD: 0.25; 95% CI: 0.07 to 0.44), and restrictive lung disease (RR: 1.34; 95% CI: 1.13 to 1.59). Post-lung transplant AAs were associated with increased all-cause mortality (adjusted RR: 1.63; 95% CI: 1.22 to 2.19) at mean follow-up of 27.8 months and length of hospital stay (36.5 16.5 days vs. 26.1 14.3 days; p < 0.001). CONCLUSIONS Early AAs post-lung transplant are associated with increased mortality and length of hospital stay. Advanced age, male sex, smoking, hypertension, hyperlipidemia, coronary artery disease, increased left atrial diameter, and restrictive lung disease are independent predictors of early AAs in post-lung transplant patients. (J Am Coll Cardiol EP 2017;-:-–-) © 2017 by the American College of Cardiology Foundation. I n the United States, the rate of lung transplantation has dramatically increased in the past 2 decades, with 1,946 surgeries reported in 2013 (1,2). Unfortunately, 5-year survival for lung m the Department of Medicine, Division of Cardiovascular Medicine, Uni kansas; Department of Medicine, Division of Cardiovascular Medicine, Un Medicine, Division of Cardiovascular Medicine, University of Iowa Carver C rdiovascular Medicine, Blackpool Teaching Hospital NHS Foundation T gdom; Department of Medicine, Cleveland Clinic Foundation, Cleve rdiology, Sidney Kimmel Medical College at Thomas Jefferson University d the Department of Medicine, Division of Pulmonary, Critical Care and rida. The authors have reported that they have no relationships relevant nuscript received October 14, 2016; revised manuscript received Novemb transplant patients has plateaued at 54%, which is significantly lower than the 5-year survival for other solid organ recipients (2–5). In addition, implementation of the Lung Allocation Score in 2005 (6) resulted versity of Arkansas for Medical Sciences, Little Rock, iversity of Florida, Gainesville, Florida; Department ollege of Medicine, Iowa City, Iowa; Department of rust, Lancashire Cardiac Centre, Blackpool, United land, Ohio; Department of Medicine, Division of /Christiana Care Health System, Newark, Delaware; Sleep Medicine, University of Florida, Gainesville, to the contents of this paper to disclose. er 18, 2016, accepted December 8, 2016. ABBR EV I A T I ON S