Purpose

Postoperative atrial arrhythmias (AA) occur in 19-39% of patients after lung transplantation and are associated with increased mortality, hospital length of stay, and risk of tracheostomy. Evidence is limited regarding AA prophylaxis strategies. The objective of this study was to evaluate the incidence of AA after lung transplantation under a universal prophylaxis strategy using diltiazem or beta blockers.

Methods

This was a retrospective review of 111 patients >18 years old who received a single or bilateral lung transplant at our institution between 7/1/2012 and 6/30/2017. The primary endpoint was occurrence of AA within 30 days after lung transplantation per electrocardiograph or documented in progress notes. Secondary endpoints included medications used for AA prophylaxis, date of first occurrence of AA, type of AA, treatment for AA, presence of known AA risk factors, intensive care unit (ICU) and hospital length of stay, occurrence of tracheostomy within 30 days post-transplant, and mortality within 30 days post-transplant.

Results

Patients in our sample were 47.7% male, 57.1+9.7 years old, and received a bilateral (61.3%), right single (17.1%), or left single (21.6%) lung transplant. Before transplant, patients were taking a beta blocker (14.4%), non-dihydropyridine calcium channel blocker (5.4%), digoxin (4.5%), or an antiarrhythmic (3.6%). Overall, 48.6% of patients had an AA within 30 days after lung transplant with a mean onset of 4.9+3.9 days. The AA was atrial fibrillation (77.8%), atrial flutter (20.4%), or other supraventricular tachycardia (20.4%). Ten patients had more than one type of AA. Among patients receiving monotherapy prophylaxis with diltiazem (n=49) or metoprolol (n=10), AA occurred in 46.9% and 50% of patients, respectively. Among the 38 patients who received various combinations of diltiazem, metoprolol, and digoxin for AA prophylaxis, AA occurred in 36.8% of patients. AA was associated with higher 30-day mortality rates (p=0.02) but did not significantly affect hospital (p=0.12) or ICU (p=0.13) length of stay.

Conclusions

Universal prophylaxis with diltiazem, metoprolol, and digoxin alone or in combination does not appear to reduce the overall incidence of AA. Our data reinforce the impact of AA on 30-day mortality.

CITATION INFORMATION: Sullivan M., Lin J., Bag R., Potter L. Incidence of Atrial Arrhythmia after Lung Transplantation with a Universal Prophylaxis Strategy Am J Transplant. 2017;17 (suppl 3).

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