Frequency, risk factors, and clinical outcomes of late-onset atrial flutter in patients after heart transplantation

• Verfasst von: Rahm, Ann-Kathrin [VerfasserIn]
• Verfasst von: Reinhardt, Susanne [VerfasserIn]
• Verfasst von: Helmschrott, Matthias [VerfasserIn]
• Verfasst von: Darche, Fabrice Fernand [VerfasserIn]
• Verfasst von: Bruckner, Thomas [VerfasserIn]
• Verfasst von: Lugenbiel, Patrick [VerfasserIn]
• Verfasst von: Thomas, Dierk [VerfasserIn]
• Verfasst von: Ehlermann, Philipp [VerfasserIn]
• Verfasst von: Sommer, Wiebke [VerfasserIn]
• Verfasst von: Warnecke, Gregor [VerfasserIn]
• Verfasst von: Frey, Norbert [VerfasserIn]
• Verfasst von: Rivinius, Rasmus [VerfasserIn]
• Titel: Frequency, risk factors, and clinical outcomes of late-onset atrial flutter in patients after heart transplantation
• Verf.angabe: Ann-Kathrin Rahm, Susanne Reinhardt, Matthias Helmschrott, Fabrice F. Darche, Tom Bruckner, Patrick Lugenbiel, Dierk Thomas, Philipp Ehlermann, Wiebke Sommer, Gregor Warnecke, Norbert Frey and Rasmus Rivinius
• E-Jahr: 2022
• Jahr: 3 October 2022
• Umfang: 17 S.
• Illustrationen: Diagramme
• Fussnoten: Gesehen am 04.01.2023
• Titel Quelle: Enthalten in: Journal of cardiovascular development and disease
• Ort Quelle: Basel : MDPI AG, 2014
• Jahr Quelle: 2022
• Band/Heft Quelle: 9(2022), 10 vom: Okt., Artikel-ID 337, Seite 1-17
• ISSN Quelle: 2308-3425
• DOI: doi:10.3390/jcdd9100337
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: atrial flutter
• Sach-SW: graft rejection
• Sach-SW: heart transplantation
• Sach-SW: immunosuppression
• Sach-SW: mortality
• Sach-SW: survival
• Sach-SW: tricuspid regurgitation
• K10plus-PPN: 1830345664

Abstract

Aims: Atrial flutter (AFL) is a common late-onset complication after heart transplantation (HTX) and is associated with worse clinical outcomes. Methods: This study investigated the frequency, risk factors, and outcomes of late-onset post-transplant AFL. We analyzed 639 adult patients undergoing HTX at the Heidelberg Heart Center between 1989 and 2019. Patients were stratified by diagnosis and type of late-onset post-transplant AFL (>90 days after HTX). Results: A total of 55 patients (8.6%) were diagnosed with late-onset post-transplant AFL, 30 had typical AFL (54.5%) and 25 had atypical AFL (45.5%). Patients with AFL were younger at HTX (p = 0.028), received more biatrial anastomosis (p = 0.001), and presented with moderate or severe tricuspid regurgitation (56.4%). Typical AFL was associated with graft rejection (p = 0.016), whereas atypical AFL was associated with coronary artery disease (p = 0.028) and stent implantation (p = 0.042). Patients with atypical AFL showed a higher all-cause 1-year mortality (p = 0.010) along with a higher rate of graft failure after diagnosis of AFL (p = 0.023). Recurrence of AFL was high (83.6%). Patients with catheter ablation after AFL recurrence had a higher 1-year freedom from AFL (p = 0.003). Conclusions: Patients with late-onset post-transplant AFL were younger at HTX, received more biatrial anastomosis, and showed a higher rate of moderate or severe tricuspid regurgitation. Typical AFL was associated with graft rejection, whereas atypical AFL was associated with myocardial ischemia, graft failure, and mortality. Catheter ablation represents a viable option to avoid further episodes of late-onset AFL after HTX.