Cardiac arrhythmia is a common complication following lung transplantation, and one that has a significant negative impact on long-term patient survival, reports a team of UPMC researchers—including McGowan Institute for Regenerative Medicine affiliated faculty members Jonathan D’Cunha, MD, PhD, James Luketich, MD, and Christian Bermudez, MD—in the largest study of its kind to date. The results provide critical information that will hopefully lead to better care of transplant recipients.
Arrhythmia, a rapid and irregular heartbeat, can lead to chest pain, stroke, and heart failure. In addition, the blood-thinning drugs often used to treat atrial fibrillation, the most common type of arrhythmia, carry risks of heavy bleeding.
“Arrhythmias present a lot of challenges for both physicians and patients. After noticing this complication in many of our lung transplant recipients, we decided to investigate how often and when it was happening, as well as any risk factors,” said lead researcher Dr. D’Cunha. “Now that we have a better understanding of these events, we can develop a standardized treatment plan, and better educate patients in advance.”
Performing 70 to 100 lung transplants per year, UPMC is one of the leaders for this procedure in the nation. In the new study, researchers examined the medical records of 652 UPMC patients who underwent a single or double lung transplant between 2008 and 2013.
They found that about 30 percent of patients developed arrhythmia, most often during the first week following surgery. Risk factors for a postoperative arrhythmia included being older and having had a previous heart surgery.
Researchers also found transplant recipients who developed an arrhythmia were 1.6 times more likely to die within 5 years than those who did not, a finding Dr. D’Cunha attributed more to the potential complications of treating arrhythmia than the abnormal heart beats themselves.
“Our study suggests that we may need to treat patients with blood thinners only for a short amount of time—until they are out of the window of highest risk—which will hopefully improve long-term outcomes,” Dr. D’Cunha explained.
In addition, because arrhythmia after lung transplant can be an anxiety-provoking experience for patients, the findings will allow surgeons to better prepare patients and families for what to expect.
“Most importantly, based on the results of this study, we can now predict, with a reasonable degree of certainty, when arrhythmia will happen,” Dr. D’Cunha said. “This allows us to begin to standardize our treatment approach and improve patient care in the postoperative setting.”
Dr. D’Cunha is an Associate Professor, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, and Chief of Lung Transplantation, Department of Cardiothoracic Surgery, UPMC. Dr. Luketich is the Henry T. Bahnson Professor of Cardiothoracic Surgery, the Chairman, Department of Cardiothoracic Surgery, the Chief, Division of Thoracic and Foregut Surgery, the Director, Thoracic Surgical Oncology, the Co-Director, Lung Cancer Center, the Associate Director of Surgical Affairs, University of Pittsburgh Cancer Institute, and the Director, Mark Ravitch/Leon C. Hirsh Center for Minimally Invasive Surgery. Dr. Bermudez is Director of Thoracic Transplantation at the University of Pennsylvania and Associate Professor of Surgery at the University of Pennsylvania School of Medicine.
Other members of the research team include Alex D’Angelo, BA, Ernest Chan, MD, J. W. Awori Hayanga, MD, MPH, David Odell, MD, MMSc, Joseph Pilewski, MD, Maria Crespo, MD, Matthew Morrell, MD, Norihisa Shigemura, MD, and Andrew Althouse, PhD, all of UPMC.
Abstract (Atrial arrhythmias after lung transplantation: Incidence and risk factors in 652 lung transplant recipients. Alex M. D’Angelo, BA, Ernest G. Chan, MD, MPH, J.W. Awori Hayanga, MD, MPH, David D. Odell, MD, MMSc, Joseph Pilewski, MD, Maria Crespo, MD, Matthew Morrell, MD, Norihisa Shigemura, MD, James Luketich, MD, Christian Bermudez, MD, Andrew D. Althouse, PhD, Jonathan D’Cunha. Journal of Thoracic and Cardiovascular Surgery; 04/29/16.)