Atrial fibrillation following lung transplantation: double but not single lung transplant is associated with long-term freedom from paroxysmal atrial fibrillation.

11:54 EDT 4th August 2015 | BioPortfolio

Summary of "Atrial fibrillation following lung transplantation: double but not single lung transplant is associated with long-term freedom from paroxysmal atrial fibrillation."

Introduction The cornerstone of catheter ablation for atrial fibrillation (AF) is pulmonary vein electrical isolation (PVI). Recurrent AF post-PVI is a major limitation of the procedure with PV reconnection present in most patients. Single (SLT) and double (DLT) lung transplant surgery involves a 'cut and sew' PV antral isolation analogous to a catheter-based approach providing an opportunity to assess the efficacy of durable PVI. Methods and results A total of three hundred and twenty-seven consecutive lung transplant patients were compared with 201 control non-transplant thoracic surgery (THR) patients between 1998 and 2008. The primary analysis was the incidence of 'early' post-operative AF and 'late' AF (AF occurring following discharge from hospital after the index operation). Risk factors for the development of late AF were analysed using regression analysis. Acute post-operative AF was more common post-lung transplant (DLT 58/200 (29%) and SLT 36/127 (28%) vs. THR 28/201 (13.9%), P < 0.001) occurring at 4.7 +/- 5.0 days in DLT, 3.4 +/- 2.5 days after SLT, and 7.4 +/- 11.2 days in the thoracic group (P < 0.001). At a mean follow-up of 5.4 +/- 2.9 years late AF occurred in 1/200 (0.5%) in DLT vs. 16/127 (12.6%) in SLT and 23/201 (11.4%, P < 0.001) in THR groups. Kaplan-Meier survival analysis demonstrated the association of DLT with long-term freedom from AF. Significant variables [hazard ratio (HR) on univariate regression analysis fo late AF were: DLT 0.06, age 1.09, LA diameter 1.2, hypertension 3.0, preoperative AF 12.2, early AF 8.8, rejection 3.2]. Conclusion Double but not SLT provides long-term freedom from AF despite a similar early post-operative incidence. This supports the critical role of the pulmonary veins in the pathogenesis of atrial fibrillation and the importance of durable electrical isolation of the pulmonary veins as the cornerstone in strategies for the long-term prevention of AF.

Affiliation

Department of Cardiology, The Melbourne Royal Melbourne Hospital, University of Melbourne, 3004 Melbourne, Australia.

Journal Details

This article was published in the following journal.

Name: European heart journal
ISSN: 1522-9645
Pages:

Links

PubMed Articles [17506 Associated PubMed Articles listed on BioPortfolio]

Single- vs Double-Lung Transplantation in Patients With Chronic Obstructive Pulmonary Disease and Idiopathic Pulmonary Fibrosis Since the Implementation of Lung Allocation Based on Medical Need.

Outcomes of single- and double-lung transplantation have not been rigorously assessed since the allocation of donor lungs according to medical need as quantified by the Lung Allocation Score, which be...

A double-blind placebo-controlled study of the effects of olprinone, a specific phosphodiesterase-III inhibitor, for preventing postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer.

We previously reported that patients with elevated preoperative B-type natriuretic peptide (BNP) levels have an increased risk for postoperative atrial fibrillation following lung cancer surgery. The ...

Is There an Age Limit to Lung Transplantation?

Lung transplantation in patients older than 65 years is increasingly common, but questions remain regarding risk vs benefit and procedure choice. We identified short-term and long-term outcomes in old...

Continued Utility of Single-Lung Transplantation in Select Populations: Chronic Obstructive Pulmonary Disease.

The use of single lung transplantation (SLTx) for chronic obstructive pulmonary disease is often viewed as inferior therapy compared with bilateral lung transplantation (BLTx). We hypothesized from o...

New predictive equation for lung volume using chest computed tomography for size matching in lung transplantation.

Lung size matching is important in lung transplantation (LT). With advances in computed tomography (CT) technology, multidetector row CT can accurately measure the thoracic cage and lung volumes. The ...

Clinical Trials [7639 Associated Clinical Trials listed on BioPortfolio]

QT-Prolongation in Lung Transplantation

Experimental intervention: electrocardiography. Control intervention: none Duration of intervention per patient/subject: 5 min, observation 6 months Key inclusion criteria: ...

Measurement of Lung Water by Transpulmonary Thermodilution in Lung Transplanted Patients

Repeated measurements of lung water by single transpulmonary thermodilution during the first postoperative days following lung transplantation

Lung Transplant Subjects Using 19F MRI

The goal of this study is to evaluate the utilization of conventional 'thermally' polarized perfluorinated gases mixed with oxygen as inhaled inert contrast agents to image the airway spac...

Vibration Response Imaging (VRI) in Lung Transplant Recipients

This study is a prospective, multi-center study. 50 lung transplant recipients will be enrolled in the study. Subjects will be selected from lung transplant recipients, who have undergone ...

Effect of Early Pulmonary Rehabilitation After Lung Transplantation

The purpose of this observation study is to evaluate the effects of an early, 3 week lasting rehabilitation program, that starts roundabout 4 weeks after lung or combined lung transplantat...

Medical and Biotech [MESH] Definitions

Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. Unlike ATRIAL FIBRILLATION which is caused by abnormal impulse generation, typical atrial flutter is caused by abnormal impulse conduction. As in atrial fibrillation, patients with atrial flutter cannot effectively pump blood into the lower chambers of the heart (HEART VENTRICLES).

Absence of air in the entire or part of a lung, such as an incompletely inflated neonate lung or a collapsed adult lung. Pulmonary atelectasis can be caused by airway obstruction, lung compression, fibrotic contraction, or other factors.

A diverse group of lung diseases that affect the lung parenchyma. They are characterized by an initial inflammation of PULMONARY ALVEOLI that extends to the interstitium and beyond leading to diffuse PULMONARY FIBROSIS. Interstitial lung diseases are classified by their etiology (known or unknown causes), and radiological-pathological features.

A lung with reduced markings on its chest radiograph and increased areas of transradiancy (hyperlucency). A hyperlucent lung is usually associated with pulmonary emphysema or PNEUMOTHORAX.

A cardiotonic glycoside obtained mainly from Digitalis lanata; it consists of three sugars and the aglycone DIGOXIGENIN. Digoxin has positive inotropic and negative chronotropic activity. It is used to control ventricular rate in ATRIAL FIBRILLATION and in the management of congestive heart failure with atrial fibrillation. Its use in congestive heart failure and sinus rhythm is less certain. The margin between toxic and therapeutic doses is small. (From Martindale, The Extra Pharmacopoeia, 30th ed, p666)


Advertisement
 

Relevant Topics

Pulmonary
Latest News Clinical Trials Research Drugs Reports Corporate
Pulmonary relating to or associated with the lungs eg Asthma, chronic bronchitis, emphysema, COPD, Cystic Fibrosis, Influenza,  Lung Cancer, Pneumonia, Pulmonary Arterial Hypertension, Sleep Disorders etc Follow and track Lung Cancer News ...

Transplantation
Latest News Clinical Trials Research Drugs Reports Corporate
Organ transplantation is the moving of an organ from one body to another or from a donor site to another location on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative ...

Advertisement
 

Searches Linking to this Article