Atrial arrhythmias following lung transplantation: A state of the art review

Table 1 Meta-analyses of atrial arrhythmias following lung transplantation

Ref.	Year	No. of studies	Total cases	AA	Conclusions
Saglietto et al[5]	2021	7	2068		This study looked only at late AA. Late atrial fibrillation rare–especially in double lung transplant (incidence rate only 0.9%/year)
Saad et al[7]	2017	12	3203	27%	Early AA increases mortality and hospital stay. Predictors of early AA are elderly age, male sex, smoking, HT, hyperlipidaemia, CAD, increased LA diameter, and restrictive lung disease
Waldron et al[8]	2017	9	2653	29.8%	AA was associated with higher mortality, longer hospital stays, increased need for tracheostomy
Fan et al[9]	2016	11	2094	31%	Risk factors include elderly age, male, prior AA, cystic fibrosis, interstitial lung disease, CAD, HT, hyperlipidaemia, LA size. Increases mortality and hospital stay

AA: atrial arrhythmias; CAD: Coronary artery disease; HT: Hypertension; LA: Left atrium.

Table 2 Incidence of post operative atrial fibrillation after different categories of surgery

Description	Incidence (%)
Transplant surgery
Lung transplantation[32,33]	17 to 46
Heart transplantation[36,37]	10 to 20
Thoracic surgery[38]
Overall cardiac surgery	Approximately 30
Coronary artery bypass surgery	Approximately 10 to 20
Thoracic (non-cardiac) surgery[38]
Overall	Approximately 15
Pneumonectomy	Approximately 30
General (non-cardiothoracic) surgery[40]	0.39

Table 3 Studies demonstrating increased mortality due to atrial arrhythmias after lung transplantation

Ref.	Year	Study type	Effect on mortality
Magnusson et al[53]	2022	Case series	Increase
Kim et al[44]	2020	Case series	Increase
Roukoz et al[6]	2018	Review	May be increased
Waldron et al[8]	2017	Meta-analysis	Increase
Saad et al[7]	2017	Meta-analysis	Increase
D'Angelo et al[54]	2016	Case series	Increase
Fan et al[9]	2016	Meta-analysis	Increase
Orrego et al[48]	2014	Case series	Increase
Henri et al[51]	2012	Case series	Increase
Isiadinso et al[35]	2011	Case series	Increase
Garcia et al[55]	2011	Case series	Increase

Table 4 Studies demonstrating no effect on mortality due to atrial arrhythmias after lung transplantation

Ref.	Year	Study type	Effect on mortality
Barnes et al[45]	2020	Case control study	No effect
Campos Silva et al[46]	2018	Case series	No effect
Jesel et al[50]	2017	Case series	No effect
Raghavan et al[56]	2015	Case series	No effect
Chaikriangkrai et al[24]	2015	Case series	No effect
Mason et al[49]	2007	Case series	No effect

Table 5 Treatment strategy in various studies of atrial arrhythmias after lung transplantation, n (%)

Ref.	Year	Study type	Lung transplantation patients	Atrial fibrillation patients	Rate control	Rhythm control	Direct current cardioversion
Campos Silva et al[46]	2018	Case series	74	32 (43)	6	72	25
Waldron et al[8]	2017	Meta-analysis	2653	791 (30)	62	47	37
D'Angelo et al[54]	2016	Case series	652	198 (30)	42	6	33
Raghavan et al[56]	2015	Case series	131	46 (35)	87	53	35
Orrego et al[48]	2014	Case series	366	93 (25)	40	28	13
Henri et al[51]	2012	Case series	224	65 (29)	40	46	28
See et al[23]	2009	Case series	127	40 (32)	56	15	15
Mason et al[49]	2007	Case series	333	68 (20)	27	8	36

Table 6 Studies describing amiodarone use in atrial arrhythmias following lung transplantation, n (%)

Ref.	Year	Study type	Atrial fibrillation patients	Amiodarone use	Notes
Magnusson et al[53]	2022	Case series	159	63 (40)	Amiodarone increase mortality but not chronic lung allograft dysfunction
Hathaway et al[43]	2021	Case series	102	77 (79)	No difference between amiodarone and others. Safe to use
Kim et al[44]	2020	Case series	46	6 (13)	No mention of any amiodarone related adverse effect
Barnes et al[45]	2020	Case control study	100	48 (alone), 26 (combination)	Recommend amiodarone as the first drug to be used
Malik et al[34]	2013	Case series	27	24 (88.9)	No mention of any amiodarone related adverse effect
Isiadinso et al[35]	2011	Case series	62	38 (65)	24 out of 38 (64%) of patients treated with amiodarone died
Diaz-Guzman et al[81]	2009	Case report	1	1 patient	Amiodarone pulmonary toxicity–resolved with cessation and steroids

Table 7 Case series on catheter ablation for atrial arrhythmias following lung transplantation, n (%)

Ref.	Year	LT patients	AA patients, n (% of LT)	CA patients, n (% of AA)	Time to CA	Outcome
Mariani et al[106]	2021			15		75% free from recurrence at median of 19 months (6-86 months)
Hussein et al[28]	2017	755	32 (4.2)	8 (25)	43 months (20-54 months)	At 3 years, 6 (75) stayed in SR. 2 patients had recurrence and 1 had re-do CA
Chaikriangkrai et al[24]	2015	293	Early 48 (16.3), late 42 (14.3)	25 (8.5)		80% of late AA were from left atrium. 20% of late AA were from right atrial
Azadani et al[52]	2011	269	35 (13)	3 (8.6)	Patient (no. 1) = 1 year. Patient (no. 2) = 28 days. Patient (no. 3) = 18 months	Patient (no. 1) = no recurrence at 1 months. Patient (no. 2) = no recurrence at 6 months. Patient (no. 3) = recurrence at 8 months and had second ablation
See et al[23]	2009	127	40 (31.5)	4 (12)		2 patients reverted to SR. 1 patient had 3 prior ablations. All 4 patients remained free of AA, 3 without anti arrhythmic drugs

AA: Atrial arrhythmias; CA: Catheter ablation; LT: Lung transplantation; SR: Sinus rhythm.

Table 8 Case reports on catheter ablation for atrial arrhythmias following lung transplantation

Ref.	Year	Type of atrial arrhythmias	How long after lung transplantation	Site of foci	Type of catheter ablation	Outcome	Notes
Guan et al[109]	2020	AT	10 years	Left PV-LA anastomosis	Radiofrequency	AT terminated	No recurrence in 3 months
Uhm et al[25]	2018	AT	10 months	PV anastomotic line–left side	RFCA	Reverted	No recurrence in 6 months. Electrical reconnection in all 4 PVs
Baykaner and Cooper[110]	2018	AFL	7 years	Left PV site	RFCA	Reverted
Itoh and Yamada[111]	2017	AFL	14 years	PV-LA right	RFCA	Reverted	Electrical reconnection noted
Sanam et al[27]	2015	AFL	9 years	Donor PV	RFCA	Reverted
Nazmul et al[26]	2011	AT	1 year	Left upper PV	RFCA	Reverted	No recurrence in 4 years
Nguyen and Marcus[107]	2010	AFL	2 months	PV-LA	RFCA	Reverted	No recurrence in 6 months
Sacher et al[108]	2008	AT	10 months	LA	RFCA	Reverted

AFL: Atrial flutter; AT: Atrial tachycardia; LA: Left atrium; PV: Pulmonary vein; RFCA: Radiofrequency catheter ablation.