Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 30:4:1601228.
doi: 10.3389/frtra.2025.1601228. eCollection 2025.

Postoperative atrial arrhythmias after bilateral lung transplantation with intraoperative V-A extracorporeal membrane oxygenation: a single-center experience

Boscolo Annalisa #  1   2 , Sella Nicolò #  2 , Zarantonello Francesco  2 , Pittorru Raimondo  3 , Mormando Giulia  4 , Bertoncello Carlo Alberto  1 , Curmaci Elena  1 , Ceccato Roberta  1 , Fincati Valentina  1 , Masetti Zannini Paola  1 , Bianco Angela  1 , Coniglio Giordana  1 , Pistollato Elisa  1 , Zambianchi Alessandro  1 , Sindi Mustaj  1 , Congedi Sabrina  1 , Roca Gabriella  3 , Peralta Arianna  2 , Muraro Luisa  2 , Pacchiarini Giorgia  2 , Migliore Federico  3 , De Lazzari Manuel  3 , Pettenuzzo Tommaso  2 , Rea Federico  3 , Perazzolo Marra Martina  3
Affiliations

Postoperative atrial arrhythmias after bilateral lung transplantation with intraoperative V-A extracorporeal membrane oxygenation: a single-center experience

Boscolo Annalisa et al. Front Transplant. .

Abstract

Introduction: Lung transplantation (LT) is the standard treatment for end-stage chronic respiratory failure that does not respond to other therapies. Advances in surgical techniques and perioperative care have improved survival rates. However, postoperative complications, particularly atrial arrhythmias (AA) remain clinically significant. Although AAs are frequently observed in the early postoperative period, data regarding their incidence and impact on outcomes are scarce. This observational study aims to: (i) assess the incidence of new-onset postoperative AA within one month of bilateral LT; (ii) evaluate their impact on short- and mid-term outcomes; and iii) identify potential predictors.

Materials and methods: We retrospectively reviewed all consecutive bilateral LT recipients admitted to the Intensive Care Unit (ICU) of the University Hospital of Padua between October 2021 and December 2023. Clinical variables, perioperative right heart catheterization data, and echocardiographic measurements were collected.

Results: A total of 85 LT recipients were enrolled. Postoperative AA occurred in 27 patients (32%), with atrial fibrillation emerging as the most common arrhythmia (55.6%). The remaining 58 (68%) patients did not develop any arrhythmic disorder. Many AA patients (22, 81.5%) required treatment with antiarrhythmic drugs or electrical cardioversion. Compared to the control group, AA patients were older (p-value 0.002) and usually affected by coronary heart disease (18.5% vs. 5.2%, p-value 0.05) and obstructive respiratory disease (55.5% vs. 27.7%, p-value 0.004). AA patients more frequently experienced difficult weaning from mechanical ventilation, a higher incidence of postoperative V-A ECMO, more frequent anastomotic complications, and longer ICU stays, as compared to controls. Multivariate analysis identified older age (OR 1.11, 95% CI 1.01-1.25, p-value 0.047) and higher postoperative dobutamine dosage (OR 2.25, 95% CI 1.15-5.01, p-value 0.026) as the only significant predictors of new-onset AA within one month of LT.

Conclusions: In our cohort, the incidence of new-onset AAs was 32% after bilateral LT. AA patients experienced worse short- and mid-term outcomes compared to controls. Furthermore, this study highlights older age and postoperative dobutamine administration as significant predictors of new-onset AA following bilateral LT. Further research is needed to clarify the causal relationships and long-term implications of AA on the clinical course of LT recipients.

Keywords: arrhythmias; atrial fibillation; extracorporeal membrane oxygenation; lung transplantation; transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Study flowchart.
See this image and copyright information in PMC

References

    1. Chambers DC, Yusen RD, Cherikh WS, Goldfarb SB, Kucheryavaya AY, Khusch K, et al. The registry of the international society for heart and lung transplantation: thirty-fourth adult lung and heart-lung transplantation report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. (2017) 36(10):1047–59. 10.1016/j.healun.2017.07.016 - DOI - PubMed
    1. Valapour M, Lehr CJ, Schladt DP, Smith JM, Goff R, Mupfudze TG, et al. OPTN/SRTR 2021 annual data report: lung. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. (2023) 23(2 Suppl 1):S379–442. 10.1016/j.ajt.2023.02.009 - DOI - PMC - PubMed
    1. Yusen RD, Edwards LB, Dipchand AI, Goldfarb SB, Kucheryavaya AY, Levvey BJ, et al. The registry of the international society for heart and lung transplantation: thirty-third adult lung and heart-lung transplant report-2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. (2016) 35(10):1170–84. 10.1016/j.healun.2016.09.001 - DOI - PubMed
    1. Stehlik J, Bavaria JE, Bax J, Cronenwett JL, Edwards LB, Fairman RM, et al. Heart, lung, and vascular registries: evolving goals, successful approaches, and ongoing innovation. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. (2016) 35(10):1149–57. 10.1016/j.healun.2016.08.021 - DOI - PubMed
    1. Dizon JM, Chen K, Bacchetta M, Argenziano M, Mancini D, Biviano A, et al. A comparison of atrial arrhythmias after heart or double-lung transplantation at a single center: insights into the mechanism of post-operative atrial fibrillation. J Am Coll Cardiol. (2009) 54(22):2043–8. 10.1016/j.jacc.2009.08.029 - DOI - PubMed

LinkOut - more resources