Postoperative Atrial Fibrillation in Lung Transplant Recipients with and without Concomitant Modified Maze.

Atrial fibrillation is common following lung transplantation and may contribute to increased risk of stroke. The goal of this study was to characterize the incidence of atrial fibrillation in lung transplant recipients with and without a concomitant modified Maze procedure. We conducted retrospective review of adult lung transplant recipients at University of California Los Angeles from June 2008 to August 2021 and identified those who received a concomitant modified Maze procedure, which were performed for intraoperative or history of atrial fibrillation or flutter when technically feasible. Baseline characteristics and incidence of post-operative atrial fibrillation were compared between Maze and non-Maze recipients. Multivariable logistic regression was used to evaluate predictors of postoperative atrial fibrillation. Of 757 lung transplant recipients identified in our cohort, 61(8%) had concomitant modified Maze. Recipients in the Maze group were older [63(57-67) vs 61(52-66), p=0.02), more likely diagnosis groups A (23% vs 15%) and B (11% vs 4%, p<0.01), had higher CVP [8(4-11) vs 5(3-8) mmHg, p<0.01], pulmonary capillary wedge pressure (13±6 vs 11±6 mmHg, p=0.03), and were more likely to have a left atrial appendage ligation (87% vs 2%, p<0.01). Post-operative atrial fibrillation was significantly higher in the Maze group (44% vs 25%, p<0.01), but no patients in the Maze group developed a stroke at the index lung transplant hospitalization. On multivariable analysis, predictors of post-operative atrial fibrillation included Maze (aOR 2.51, 95% CI 1.40-4.50), male recipient (aOR 1.71, 95% CI 1.18-2.46), hypertension (aOR 1.54, 95% CI 1.09-2.18), BMI (aOR 1.07 per kg/m2, 95% CI 1.07), and white (aOR 5.30, 95% CI 1.53-18.36) and Hispanic race (aOR 3.75, 95% CI 1.05-13.44). Lung transplant recipients with atrial fibrillation and receiving concomitant Maze still have a significantly higher rate of postoperative atrial fibrillation compared to those who do not require Maze. These patients should have their left atrial appendage ligated when technically feasible to reduce the future risk of stroke. [ABSTRACT FROM AUTHOR]