Review
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 18, 2025; 15(2): 101005
Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.101005
Atrial arrhythmias following lung transplantation: A state of the art review
Thirugnanasambandan Sunder, Paul Ramesh, Madhan Kumar
Thirugnanasambandan Sunder, Paul Ramesh, Madhan Kumar, Department of Heart Lung Transplantation and Mechanical Circulatory Support, Apollo Hospitals, Chennai 600086, Tamil Nadu, India
Author contributions: Sunder T conceived the idea, collected references and wrote the paper; Ramesh P suggested format, collected the references, reviewed and approved the manuscript; Kumar M collected the reference articles, suggested headings, reviewed and approved the manuscript; all the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thirugnanasambandan Sunder, Professor, Department of Heart Lung Transplantation and Mechanical Circulatory Support, Apollo Hospitals, Greams Lane Off Greams Road, Chennai 600086, Tamil Nadu, India. sunder64@gmail.com
Received: September 1, 2024
Revised: October 25, 2024
Accepted: November 19, 2024
Published online: June 18, 2025
Processing time: 172 Days and 17.5 Hours
Abstract

Lung transplantation (LT) is now an accepted therapy for end stage lung disease in appropriate patients. Atrial arrhythmias (AA) can occur after LT. Early AA after LT are most often atrial fibrillation, whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia. The causes of AA are multifactorial. The review begins with a brief history of LT and AA. This review further describes the pathophysiology of the AA. The risk factors, incidence, recipient characteristics including intra-operative factors are elaborated on. Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT, the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia. The strategy of rate control vs rhythm control is discussed. The pros and cons of various drug regimen, need for direct current cardioversion and catheter ablation therapies are considered. Possible methods to prevent or reduce the incidence of AA after LT are considered. The impact of AA on the short-term and long-term outcomes following LT is discussed.

Keywords: Lung transplantation; Atrial arrhythmias; Atrial fibrillation; Atrial flutter; Atrial tachycardia; Rate control drugs; Rhythm control drugs; Catheter ablation; Post operative; Anticoagulation

Core Tip: While atrial arrhythmias (AA) after lung transplantation (LT) continue to be challenging, there has been an increase in our understanding of the mechanisms of these arrhythmias. Early arrhythmias are commonly due to atrial fibrillation and late arrhythmias are often atrial tachycardia. While the main treatment of early perioperative arrhythmia is drug therapy or cardioversion, the late stable arrhythmias can now be successfully treated by catheter ablation. Prophylactic measures to prevent arrhythmia are needed. In the absence of specific guidelines to treat AA after LT, further studies are needed to evaluate methods to prevent or reduce the incidence.