Moon Y-J, Kwon H-M, Park Y-S, Kim S-H, Hwang G-S
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Transplant Proc. 2018 May;50(4):1142-1146. doi: 10.1016/j.transproceed.2018.01.039.
Although patients undergoing liver transplantation (LT) are frequently exposed to predisposing factors of atrial fibrillation (AF) such as autonomic imbalance, surgical stress, and elevated catecholamine levels, the occurrence of intraoperative AF (IOAF) has not been fully examined in LT candidates.
Data from 1059 patients who underwent adult LT from 2006 to 2010 were analyzed. Among patients with preoperative normal sinus rhythm, the incidence, prognosis, and detailed characteristics of newly developed IOAF were assessed. Their risk factors and clinical implication, including hepatic graft survival and mortality, were also examined.
Thirteen (1.2%) cases of AF newly developed intraoperatively. A higher Model for End-Stage Liver Disease score (adjusted odds ratio, 1.077 [95% confidence interval, 1.015-1.143]; P = .015) and fulminant hepatic failure (adjusted odds ratio, 6.844 [95% CI, 1.944-24.096]; P = .003) were associated with its occurrence. Eight cases of newly developed AF occurred immediately after hepatic graft reperfusion; the other 3 cases occurred during the pre-anhepatic or anhepatic phase. The majority of patients (9 cases) experienced only brief episodes of AF lasting <1 hour. Despite all patients with newly developed AF eventually converting to sinus rhythm within 1 week after surgery, the episode of IOAF was independently associated with mortality (adjusted hazard ratio, 5.097 [95% confidence interval, 2.189-11.868]; P < .001) after adjustment for Model for End-Stage Liver Disease score.
For LT recipients, even a brief episode of newly developed IOAF seems to be an important prognosticator, regardless of AF duration.
尽管接受肝移植（LT）的患者经常暴露于心房颤动（AF）的诱发因素，如自主神经失衡、手术应激和儿茶酚胺水平升高，但肝移植候选者术中房颤（IOAF）的发生情况尚未得到充分研究。
分析了2006年至2010年接受成人肝移植的1059例患者的数据。在术前窦性心律正常的患者中，评估新发生的IOAF的发生率、预后及详细特征。还检查了其危险因素和临床意义，包括肝移植存活和死亡率。
术中新发生13例（1.2%）房颤。终末期肝病模型评分较高（校正比值比，1.077[95%置信区间，1.015 - 1.143]；P = 0.015）和暴发性肝衰竭（校正比值比，6.844[95%CI，1.944 - 24.096]；P = 0.003）与房颤发生相关。8例新发生的房颤在肝移植再灌注后立即出现；另外3例发生在无肝前期或无肝期。大多数患者（9例）仅经历了持续时间<1小时的短暂房颤发作。尽管所有新发生房颤的患者最终在术后1周内恢复窦性心律，但在调整终末期肝病模型评分后，IOAF发作与死亡率独立相关（校正风险比，5.097[95%置信区间，2.189 - 11.868]；P < 0.001）。
对于肝移植受者，即使是新发生的短暂IOAF发作似乎也是一个重要的预后指标，与房颤持续时间无关。
