ECG-based detection of an atrial cardiomyopathy allows identification of patients at risk for postoperative supraventricular arrhythmias after lung transplant

Background: Postoperative supraventricular arrhythmias (SVA) frequently occur after lung transplant (LTX) and are associated with an increased risk of morbidity and mortality. An atrial cardiomyopathy (ACM) is a known risk factor for new-onset SVA and can be detected non-invasively by measurement of the p-wave-duration on electrocardiogram (ECG). However, studies investigating the impact of ACM on the occurrence of SVAs in patients undergoing LTX are lacking. Aims and objectives: The aim of the current study is to investigate whether ECG-based ACM-detection is associated with the risk of postoperative SVAs in patients who underwent LTX. Methods: We retrospectively screened 134 patients who underwent first LTX at the University of Freiburg between 2014 and 2022. In 64 of these patients (median age: 60 years, 53 % male), a digital ECG prior to LTX was available and patients survival was at least one month post LTX. P-wave duration has been measured after amplification of the digital ECG to 80 mm/mV and 175 mm/s. SVAs were defined as an episode lasting >30 seconds on telemetry monitoring on intensive care unit or diagnosed in 12-lead ECG on normal ward. Results: Postoperative SVAs occurred in 33 patients (52%) after LTX. The risk of SVAs was significantly associated with a prolonged p-wave duration with an increase of 6% with every millisecond duration (p=0.031) and remained significant after adjustment for age, sex and BMI (p=0.042). Conclusions: Detection of an ACM diagnosed by a prolonged p-wave duration in patients undergoing LTX allows to identify patients at risk for postoperative SVAs who should be monitored more closely.