Arrhythmias as the dominant phenotype of early cardiovascular events after liver transplantation
C Huerta, M Mogg, W Giesing, A Abdulmanan, A Khetani, C Delgado, B Barrientos, H Cheema, N KhanAbstract
Background
Cardiovascular complications are a major cause of morbidity after liver transplantation; however, the predominant phenotype of early post-transplant events remains incompletely characterised. This study aimed to evaluate whether early post-transplant cardiovascular events are predominantly arrhythmic rather than ischaemic in nature.
Purpose
To define the clinical phenotype of one-year major adverse cardiovascular events (MACE) after liver transplantation and determine the relative contribution of arrhythmic versus ischaemic complications.
Methods
We conducted a retrospective single-centre cohort study of 637 consecutive adult patients undergoing orthotopic liver transplantation between 1 January 2017 and 31 December 2024. The primary endpoint was MACE occurring within one year of transplantation. MACE was defined as a composite of myocardial infarction, new or decompensated heart failure, new or worsening pulmonary hypertension, cardiogenic shock, cardiac arrest, clinically significant arrhythmia, cardiovascular death, or cerebrovascular accident. Time to first event was calculated from the date of transplantation. All suspected cardiovascular events were adjudicated by structured chart review and categorised according to predefined clinical subtypes.
Results
Within one year, 89 patients (14.0%) experienced MACE. Arrhythmias were the predominant event type, accounting for 48 of 89 events (53.9%). Cardiac arrest occurred in 14 patients (15.7%), and new or decompensated heart failure in 13 (14.6%). Cerebrovascular accident was observed in 5 cases (5.6%), while myocardial infarction occurred in 2 patients (2.2%). Arrhythmic events occurred early after transplantation, with a median time to event of 2.5 days (interquartile range 0.0–11.5 days), and 83.3% occurring within 30 days. Among arrhythmias, atrial fibrillation was most frequent (31/48, 64.6%), followed by supraventricular tachycardia (6/48, 12.5%). Bradyarrhythmias and non-sustained ventricular tachycardia each accounted for 6.2% of arrhythmic events. Sustained ventricular tachycardia and ventricular fibrillation were infrequent.
Conclusion
In this cohort, early post-transplant cardiovascular events were predominantly arrhythmic rather than ischaemic, with atrial fibrillation representing the most common MACE phenotype. These findings suggest that early cardiovascular risk after liver transplantation may be driven more by perioperative electrophysiologic and haemodynamic instability, including autonomic dysregulation, altered loading conditions, and cirrhotic cardiomyopathy, than by obstructive coronary disease. This pattern highlights the importance of early rhythm surveillance and haemodynamic optimisation in this high-risk population.Figure 1:A/BFigure: 2