Postoperative Atrial Arrhythmias After Lung Transplantation: A Single Center Analysis of Risk Factors, Management, and Outcomes

BACKGROUND: Postoperative atrial arrhythmia (POAA) is common after lung transplant, but data on its implications and management are limited. This study assessed POAA incidence and timing, its association with mortality and rehospitalizations, and outcomes related to postoperative beta-blocker use. METHODS: We retrospectively studied 233 adult lung transplant patients at Northwestern Memorial Hospital (2014-2024) without prior atrial arrhythmia. POAA, defined as atrial fibrillation or flutter, was confirmed by ECG or ambulatory monitoring. Multivariable logistic and Cox regression models evaluated predictors and outcomes, adjusting for covariates. RESULTS: POAA occurred in 69/233 patients (29.6%) and was associated with higher mortality (HR3.09, 95%CI [1.57-6.08]). Among these, 18/69 (26.1%) developed POAA after the index hospitalization at median 216 days post-transplant, also associated with higher mortality (HR4.37, 95%CI [1.90-10.06]). Additionally, 10/69 (14.5%) required emergency visits or hospitalization specifically for arrhythmia management, and 66.6% underwent additional rhythm control (2.9% cardioversion, 46.4% anti-arrhythmic drug, 17.4% both). Postoperative beta-blocker use was associated with 73% less POAA (HR0.27, 95%CI [0.09-0.80]). CONCLUSION: POAA was common and clinically significant after lung transplant, associated with substantially higher adjusted mortality even when occurring after index hospitalization. We report for the first time that POAA was frequently associated with emergency visits or rehospitalization for arrhythmia, highlighting its clinical burden well beyond the perioperative period. Postoperative beta-blocker use was associated with markedly less POAA, a novel finding suggesting a potential prophylactic role. Overall, these findings challenge the traditional view of POAA as benign and highlight the need for tailored, evidence-based guidelines in this high-risk population.