Efficacy and safety of catheter ablation for atrial arrhythmias in solid transplant recipients: a single-centre experience

Abstract Background Atrial arrhythmias are common among solid organ transplant recipients and are associated with increased morbidity and mortality in this population. This is partially due to prolonged immunosuppression, which can adversely affect atrial tissue. Catheter ablation may be beneficial as pharmacological treatments are often not tolerated or are limited due to organ rejection risks and immunotherapy. However, data concerning the efficacy and safety of this approach are limited. Purpose This study aimed to evaluate the efficacy and safety of catheter ablation in solid organ transplant recipients. Methods A single-centre observational study was conducted over 32 months. Nineteen consecutive patients with atrial arrhythmias, referred for catheter ablation, were enrolled. The ablations were performed using either radiofrequency (RF) or pulse-field energy. Follow-up assessments were conducted in an outpatient clinic. Results A total of 22 procedures in 19 patients (15 males, median age 65.5 years) were included in the final analysis. The cohort comprised 17 kidney transplant recipients, 5 liver transplant recipients (with one patient having undergone both liver and kidney transplantation), and 1 pancreas transplant recipient. Indications for catheter ablation included 8 cases of paroxysmal atrial fibrillation (AF), 11 cases of persistent AF, 1 case of typical atrial flutter (AFL), and 2 cases of left macro-reentry atrial tachycardia. Catheter ablation using RF energy was performed in 15 patients, while pulse-field ablation was used in 7 patients. The median follow-up duration was 370 days (interquartile range: 252-501 days). The success rate, defined by lack of AT/AF episodes in 12 lead ECG, 24-hour ECG Holter and the absence of symptomatic atrial tachycardia or atrial fibrillation recurrence, was 73%. Notably, no periprocedural complications were noted in this patient population. Conclusions Catheter ablation for atrial arrhythmias in solid organ transplant recipients is both effective and safe concerning the occurrence of periprocedural complications.