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.