ATRIAL-FLUTTER - A NEWLY RECOGNIZED COMPLICATION OF PEDIATRIC LUNG TRANSPLANTATION

Background and methods: Atrial Butter after pediatric lung transplanta tion has not previously been reported. We reviewed the records of 78 c hildren who underwent lung transplantation at our institution to chara cterize the incidence and clinical course of postoperative atrial Butt er, The diagnosis was based on either a surface or transesophageal ele ctrocardiogram that demonstrated a fixed cycle length atrial tachycard ia that did not require ventricular participation. Results: Atrial flu tter occurred in seven of 62 (11.3%) patients who underwent bilateral sequential lung transplantation, zero of 10 patients after single lung transplantation. and zero of six patients after heart-lung transplant ation. Ages of the patients with atrial Butter ranged from 2.5 months to 14 years. Electrocardiographic findings among patients varied with respect to p-wave morphology and atrioventricular conduction. No patie nt had a prior atrial arrhythmia or coexisting structural cardiac dise ase. None had atrial flutter in relation to a rejection episode. Two p atients had atrial flutter transiently during the first postoperative day, hut it resolved spontaneously. Five patients had recurrent atrial flutter that began 13 +/- 7 days after the operation. The mean cycle length of atrial Butter was 196 +/- 65 msec The arrhythmia was unrespo nsive to digoxin in four patients to whom it was administered, It was controlled with procainamide in four patients and with flecainide in o ne. At 1 and 6 months after lung transplantation, procainamide was dis continued in two patients without recurrence One patient died of bronc hiolitis obliterans 6 months after the operation while stilt receiving flecainide Two patients continue to receive procainamide 4 and 7 mont hs after transplantation, Conclusion: (1) Atrial flutter commonly occu rs after bilateral lung transplantation in children, (2) Electrocardio graphic manifestations are variable, (3) Type 1 antiarrhythmic agents provide satisfactory control.