B-PO04-080 ELECTROPHYSIOLOGIC CHARACTERISTICS AND ABLATION OUTCOMES FOR ATRIAL ARRHYTHMIAS IN LUNG TRANSPLANT PATIENTS

Abstract

Atrial arrhythmias (AA) after lung transplantation (LT) have been attributed to scar resulting from the surgical anastomoses in the left atrium. Arrhythmia sites of origin and mechanisms in LT patients have been incompletely described. We investigated the electrophysiological mechanisms of AA and outcomes after catheter ablation in LT patients from a high-volume LT center. Retrospective observational study of LT patients who underwent catheter ablation for symptomatic AA. Patient demographics, operative, electrophysiologic and catheter ablation data, complications, and outcomes were collected. Arrhythmia mechanisms were determined by entrainment. Six patients were included (50% female), mean age 48.8 years. At EP study, the pulmonary veins (PV) were electrically isolated in 22 out 24 veins (92%). Eleven AA were observed: 6 focal atrial tachycardias (5 in the left atrium (LA) and 1 in the right atrium (RA)) and 4 macro-reentry (3 in the LA and 1 cavo-tricuspid isthmus dependent RA flutter). Macro-reentry LA flutters exclusively localized to the L pulmonary vein cuff (figure 1). The acute ablation success rate was 100%. Over a median follow-up of 24.5 months, two patients had recurrence of AA treated with antiarrhythmic drugs, both had focal AT at the time of ablation procedure. No complications occurred. In this series, AA post LT commonly had a left atrial origin, with a balance of focal and macro-reentry mechanisms. LA macro-reentry involved L sided PV antra exclusively. Catheter ablation was acutely successful; one third of patients developed a recurrence.