Incidence, predictors, and outcomes of atrial fibrillation and stroke after heart transplantation.

BACKGROUND

Atrial fibrillation (AF) occurs after heart transplantation (HT) and may increase morbidity and mortality; however, data on its incidence, predictors, and outcomes remain limited.

OBJECTIVE

This study aimed to evaluate the incidence of AF and stroke after HT and identify predictors and outcomes of post-HT AF.

METHODS

We conducted a retrospective study of adult patients who underwent HT at a high-volume center between January 1, 2005, and September 30, 2024. AF was classified as early (<30 days after HT) or late (≥30 days). Clinical variables for both the recipient and the donor were collected. Separate CHA2DS2-VASc scores were calculated using recipient and donor age. Predictors of early and late AF were assessed using univariate and multivariable logistic regression.

RESULTS

Among 1072 patients (median age 55 years [interquartile range 45-63]; 75% male), AF occurred in 11% (n = 111), most commonly as late or combined early and late AF. Donor age, post-HT extracorporeal membrane oxygenation, and pericardial effusion predicted early AF, whereas rejection, cardiac allograft vasculopathy, and early AF predicted late AF. Stroke occurred in 9% of patients and was independently associated with pre-HT mechanical circulatory support and ischemic time but not AF. CHA2DS2-VASc scores incorporating recipient and donor factors predicted post-HT stroke; the donor-derived score also predicted AF. Survival was similar through 3 years after HT but was lower in patients with AF at 5 years (72% vs 86%; P < .01).

CONCLUSION

AF after HT is associated with reduced long-term survival. Both donor and recipient factors contribute, and donor age-derived CHA2DS2-VASc scoring may aid risk stratification and surveillance.