Effect of Atrial Arrhythmias on Outcomes After Lung Transplant: A Single Institution Study
Hussain AlShimali1, Antonio Coppolino1, Daniel E. Rinewalt1, Mohamed A. Keshk1, John S. Young1, Ashraf Sabe1, Hilary J. Goldberg2, Nirmal S. Sharma2, Aaron B. Waxman2, Paul C. Zei3, Thomas M. Tadros3, *Hari R. Mallidi1
1Thoracic and cardiac surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States, 2Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, United States, 3Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
Objectives: Lung transplantation is the only option for many patients with end-stage lung diseases. Atrial arrhythmias (AA) are one of the most common peri-operative complications following lung transplantation. This study aims to evaluate the impact of AA on post-surgical clinical outcomes.
Methods: We conducted a retrospective cohort study of patients who underwent lung transplant between 2015 and 2021. Three hundred and twenty patients were categorized into two groups, post-lung transplant AA and no AA. Cases that underwent heart-lung transplantation and re-lung transplantation were excluded. Multivariable logistic regression analyses were used to study risk factors for arrhythmia development. A multivariable Cox proportional hazard model was used to compare the overall survival between the groups.
Results: Diagnosis of restrictive lung disease (OR 2.61 95%CI 1.3-5.28; p-value 0.006) and history of AA (OR 3.33 95%CI 1.1-11.7; p-value 0.04) were significantly associated with AA development after lung transplant. Perioperative hospital stay, ICU length of stay, and hospital length of stay were significantly increased in patients in the AA group with a p-value <0.001 in all subgroups. Notably, there was no association between AA and primary graft dysfunction or graft rejection. Overall mortality between groups was higher in the AA group (p-value = 0.044).
Conclusions: Restrictive lung disease patients with a history of AA were the most likely to develop post-operative AA. These arrhythmias were associated with decreased survival and increased resource utilization.
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