Abstract 14728: Atrial Fibrillation After Orthotopic Heart Transplantation: Results From a Meta-analysis

Abstract

Background: Atrial fibrillation (AF) is a known complication of orthotopic heart transplantation (OHT). However, post-OHT AF is yet to be well characterized as studies report diverse data on the incidence rate and clinical characteristics of this arrhythmia. This study provides a review and meta-analysis of the existing evidences on the incidence rate, time of onset and association with allograft rejection of post-OHT AF. Methods: An extensive literature search was performed on PubMed, MEDLINE and EMBASE databases (from 1990 to August 2014) and reference lists of selected articles for studies on the incidence of atrial fibrillation in OHT patients. Post OHT arrhythmia incidence data along with population characteristics were collected and pooled prevalence rate and associated 95% confidence intervals (CIs) were calculated. Results: Ten prospective studies with 3,852 patients undergoing OHT were included in the primary meta-analysis. The pooled prevalence of AF across studies was 5.4% (95% CI 7.0-10.1). AF was the most common early arrhythmia; 74% (95% CI 65-83) of the reported AF episodes were observed in <30 days of OHT. The pooled prevalence of AF was much higher with allograft rejection (41.5%, 95% CI 32-52, p<0.001). Additionally, two studies reported lower incidence of AF following OHT compared to the AF-incidence after other cardiac surgeries such as MAZE and double- lung transplantation, despite pulmonary vein isolation in both groups (relative OR 0.25, 95% CI 0.07-0.56), which they attributed to the antiarrhythmic benefit of cardiac denervation in the transplanted heart. Conclusion: In heart transplant recipients atrial fibrillation is uncommon; mostly seen in the early post-operative period and often in the presence of graft rejection. Of note, cardiac autonomic denervation may have a protective antiarrhythmic effect in the post-operative setting of orthotopic heart transplantation.