Rahm Ann-Kathrin, Reinhardt Susanne, Helmschrott Matthias, Darche Fabrice F, Bruckner Tom, Lugenbiel Patrick, Thomas Dierk, Ehlermann Philipp, Sommer Wiebke, Warnecke Gregor, Frey Norbert, Rivinius Rasmus
Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, 69120 Heidelberg, Germany.
J Cardiovasc Dev Dis. 2022 Oct 3;9(10):337. doi: 10.3390/jcdd9100337.
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.
心房颤动（AFL）是心脏移植（HTX）后常见的晚期并发症，且与更差的临床结局相关。方法：本研究调查了移植后晚期AFL的发生率、危险因素及结局。我们分析了1989年至2019年在海德堡心脏中心接受HTX的639例成年患者。根据移植后晚期AFL（HTX后>90天）的诊断和类型对患者进行分层。结果：共有55例患者（8.6%）被诊断为移植后晚期AFL，其中30例为典型AFL（54.5%），25例为非典型AFL（45.5%）。AFL患者HTX时更年轻（p = 0.028），接受双心房吻合术的比例更高（p = 0.001），且存在中度或重度三尖瓣反流（56.4%）。典型AFL与移植物排斥相关（p = 0.016），而非典型AFL与冠状动脉疾病（p = 0.028）和支架植入相关（p = 0.042）。非典型AFL患者全因1年死亡率更高（p = 0.010），且在诊断AFL后移植物失败率更高（p = 0.023）。AFL复发率很高（83.6%）。AFL复发后接受导管消融的患者1年无AFL率更高（p = 0.003）。结论：移植后晚期AFL患者HTX时更年轻，接受双心房吻合术的比例更高，且中度或重度三尖瓣反流率更高。典型AFL与移植物排斥相关，而非典型AFL与心肌缺血、移植物失败和死亡率相关。导管消融是避免HTX后晚期AFL再次发作的可行选择。
