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Clinical significance of postoperative atrial arrhythmias in patients who underwent lung transplantation

Korean Journal of Internal Medicine 2020년 35권 4호 p.897 ~ 905
김병규 ( Kim Byung-Gyu ) - Inje University Seoul Paik Hospital Department of Internal Medicine

엄재선 ( Uhm Jae-Sun ) - Yonsei University College of Medicine Severance Hospital Department of Internal Medicine Division of Cardiology
양필성 ( Yang Pil-Sung ) - CHA University CHA Bundang Medical Center Department of Internal Medicine
유희태 ( Yu Hee-Tae ) - Yonsei University College of Medicine Severance Hospital Department of Internal Medicine Division of Cardiology
김태훈 ( Kim Tae-Hoon ) - Yonsei University College of Medicine Severance Hospital Department of Internal Medicine Division of Cardiology
정보영 ( Joung Bo-Young ) - Yonsei University College of Medicine Severance Hospital Department of Internal Medicine Division of Cardiology
박희남 ( Pak Hui-Nam ) - Yonsei University College of Medicine Severance Hospital Department of Internal Medicine Division of Cardiology
김송이 ( Kim Song-Yee ) - Yonsei University College of Medicine Severance Hospital Department of Internal Medicine Division of Pulmonology
박무석 ( Park Moo-Suk ) - Yonsei University College of Medicine Severance Hospital Department of Internal Medicine Division of Pulmonology
이진구 ( Lee Jin-Gu ) - Yonsei University College of Medicine Severance Hospital Department of Thoracic and Cardiovascular Surgery
백효채 ( Paik Hyo-Chae ) - Yonsei University College of Medicine Severance Hospital Department of Thoracic and Cardiovascular Surgery
이문형 ( Lee Moon-Hyoung ) - Yonsei University College of Medicine Severance Hospital Department of Internal Medicine Division of Cardiology

Abstract


Background/Aims: Atrial arrhythmia (AA) occasionally occurs after lung transplantation (LT); however, risk factors for AA and their impact on clinical outcomes are inconsistent. We aimed to investigate the incidence, predisposing factors, and clinical outcomes of AA after LT.

Methods: We retrospectively evaluated 153 consecutive patients who underwent LT between January 2010 and August 2016. An AA episode was defined as a documented atrial fibrillation (AF), atrial flutter, or atrial tachycardia on 12-lead electrocardiography or episodes lasting ≥ 30 seconds on telemetry monitoring.

Results: The mean follow-up time was 22.0 ± 19.1 months. Postoperative AA occurred in 46 patients (30.1%) after LT. Patients with postoperative AA were older, had larger body surface area, and had an increased incidence of paroxysmal AF prior to transplantation, idiopathic pulmonary fibrosis, and postoperative tracheostomy than patients without AA. Preoperative right atrial pressure (RAP) (odds ratio [OR], 1.19; p = 0.005) and longer periods of mechanical ventilation (OR, 1.03; p = 0.008) were found to be independent risk factors for AA after surgery. Development of AA was a significant predictor of long-term overall mortality (hazard ratio, 2.75; p = 0.017).

Conclusions: Patients with elevated preoperative RAP and long-term ventilator care had a higher risk of AA after LT. Further, AA after LT was associated with poor long-term survival.

키워드

Lung transplantation; Atrial fibrillation; Atrial f lutter; Tachycardia, ectopic atrial; Survival
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