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Catheter ablation of atrial arrhythmias following lung transplant: Electrophysiological findings and outcomes
Author(s) -
Mariani Marco V.,
Pothineni Naga Venkata K.,
Arkles Jeffrey,
Deo Rajat,
Frankel David S,
Supple Gregory,
Garcia Fermin,
Lin David,
Hyman Matthew C.,
Kumareswaran Ramanan,
Riley Michael,
Nazarian Saman,
Schaller Robert D.,
Epstein Andrew E.,
Bermudez Christian,
Dixit Sanjay,
Callans David,
Marchlinski Francis E.,
Santangeli Pasquale
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14816
Subject(s) - medicine , cardiology , atrial fibrillation , atrial flutter , pulmonary vein , catheter ablation , ablation , atrial tachycardia
Data on the mechanisms of atrial arrhythmias (AAs) and outcomes of catheter ablation (CA) in lung transplantation (LT) patients are insufficient. We evaluated the electrophysiologic features and outcomes of CA of AAs in LT patients. Methods and Results We conducted a retrospective study of all the LT patients who underwent CA for AAs at our institution between 2004 and 2019. A total of 15 patients (43% males, age: 61 ± 10 years) with a history of LT (60% bilateral and 40% unilateral) were identified. All patients had documented organized AA on surface electrocardiogram and seven patients also had atrial fibrillation (AF; 47% with >1 clinical arrhythmia). At electrophysiological study, 19 organized AAs were documented (48% focal and 52% macro‐re‐entrant). Focal atrial tachycardias/flutters were targeted along the pulmonary vein (PV) anastomotic site at the left inferior PV ( n = 2), ridge and carina of the left superior PV ( n = 2), left atrium (LA) posterior wall ( n = 3), LA roof ( n = 1), and tricuspid annulus ( n = 1). Macro‐re‐entrant AAs included cavotricuspid isthmus‐dependent flutter ( n = 2), incisional LA flutter ( n = 4), LA roof‐dependent flutter ( n = 1), and mitral annular flutter ( n = 3). In patients with LA mapping ( n = 13), PV reconnection on the side of the LT was found in six patients (40%, all with clinically documented AF), with a mean of 2.1 ± 0.9 PVs reconnected per patient. Patients with AF underwent successful PV isolation. After a median follow‐up of 19 months (range: 6–86 months), 75% of patients remained free from recurrent AAs. No procedural major complications occurred. Conclusion In patients with prior LT, recurrent AAs are typically associated with substrate surrounding the surgical anastomotic lines and/or chronically reconnected PVs. CA of AAs in this population is safe and effective to achieve long‐term arrhythmia control.