Y-J Moon1, H-M Kwon1, Y-S Park1, S-H Kim2, G-S Hwang1. 1. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 2. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: shkimans@amc.seoul.kr.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: For LT recipients, even a brief episode of newly developed IOAF seems to be an important prognosticator, regardless of AF duration.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: For LT recipients, even a brief episode of newly developed IOAF seems to be an important prognosticator, regardless of AF duration.
Authors: Manhal Izzy; Brett E Fortune; Marina Serper; Nicole Bhave; Andrew deLemos; Juan F Gallegos-Orozco; Cesar Guerrero-Miranda; Shelley Hall; Matthew E Harinstein; Maria G Karas; Michael Kriss; Nicholas Lim; Maryse Palardy; Deirdre Sawinski; Emily Schonfeld; Anil Seetharam; Pratima Sharma; Jose Tallaj; Darshana M Dadhania; Lisa B VanWagner Journal: Am J Transplant Date: 2022-03-31 Impact factor: 9.369
Authors: Jessica T Huynh; Jeff S Healey; Kevin J Um; Maria E Vadakken; Anand S Rai; David Conen; Pascal Meyre; Jawad H Butt; Hooman Kamel; Seleman J Reza; Stephanie T Nguyen; Zardasht Oqab; P J Devereaux; Kumar Balasubramanian; Alexander P Benz; Emilie P Belley-Cote; William F McIntyre Journal: CJC Open Date: 2021-01-12