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World J Transplant. Sep 18, 2026; 16(3): 122203
Published online Sep 18, 2026. doi: 10.5500/wjt.122203
Post-transplant atrial tachyarrhythmias: Epidemiology, mechanisms, outcomes, and management across solid organs
Alexandra Régia Dantas Brigido, Hugo Cardoso de Souza Falcon, Vanessa Simioni Faria, Helena Garcia Betinardi Bernardi, Júlio César Vieira de Sousa, Deborah de Sá Pereira Belfort, Guilherme Dagostin de Carvalho, Paulo Ricardo Gessolo Lins
Alexandra Régia Dantas Brigido, Hugo Cardoso de Souza Falcon, Deborah de Sá Pereira Belfort, Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Vanessa Simioni Faria, Center for Advanced Heart Disease, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Helena Garcia Betinardi Bernardi, Hospital Nossa Senhora, Hospital de Amor, Barretos 14780-070, São Paulo, Brazil
Júlio César Vieira de Sousa, Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal 59078-970, Rio Grande do Norte, Brazil
Guilherme Dagostin de Carvalho, Department of Cardiac Arrhythmias and Electrophysiology, Dante Pazzanese Institute of Cardiology, São Paulo 04012-909, Brazil
Paulo Ricardo Gessolo Lins, Department of Medicine, Federal University of São Paulo, São Paulo 04023-900, Brazil
Author contributions: Brigido ARD conceived the review, coordinated the project, drafted the manuscript, formatted the article, and performed the final revision; Falcon HCS, Faria VS, Belfort DSP, Sousa JCV, Bernardi HGB, Carvalho GD, and Lins PRG contributed to the literature review and drafting of manuscript sections; Faria VS reviewed the manuscript for English language and clarity; Sousa JCV and Lins PRG contributed to the final critical revision for important intellectual content. All authors reviewed and approved the final manuscript.
AI contribution statement: ChatGPT was used only for English language polishing and editing, including grammar, clarity, readability, and flow. Claude AI was used only as an assistive tool for visual and layout refinement of figures, flowcharts, and diagrams. No AI tool was used to generate scientific content, formulate the study design, perform data analysis, interpret findings, create or modify data, or draw conclusions. All AI-assisted outputs were critically reviewed and approved by the authors, who take full responsibility for the final content of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Alexandra Régia Dantas Brigido, MD, Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Avenida Dr. Enéas de Carvalho Aguiar, 44, Cerqueira César, São Paulo 05403-000, Brazil.
alexandrabrigido@gmail.com
Received: April 13, 2026
Revised: June 1, 2026
Accepted: July 9, 2026
Published online: September 18, 2026
Processing time: 139 Days and 8.7 Hours
Post-transplant atrial tachyarrhythmias - including atrial fibrillation (AF), atrial flutter, and organized atrial tachycardias - occur after solid-organ transplantation and follow distinct time- and organ-dependent patterns. Early arrhythmias are mainly postoperative, resulting from inflammatory and autonomic stress, hemodynamic and metabolic shifts, and atrial injury. Thoracic transplantation bears the highest burden: Early postoperative AF is frequent, while late arrhythmias typically present as macroreentrant tachycardias at anastomotic or incisional sites. These late arrhythmias can signal graft pathology or atrial remodeling. In heart transplantation, late atrial tachyarrhythmias depend on surgical technique and often coincide with rejection or cardiac allograft vasculopathy. In abdominal transplantation, AF is less common but remains relevant. In liver transplantation, AF links closely to advanced disease and perioperative instability, with poorer outcomes. Across organs, post-transplant AF leads to longer hospitalization and higher risks of thromboembolism, mortality, and graft loss, emphasizing its significance beyond a brief postoperative event. Management is complex and multidisciplinary, requiring careful evaluation for reversible causes, patient-specific rate-control or rhythm-control, and attention to interactions among antiarrhythmics, anticoagulants, and immunosuppressive agents. Rhythm control is increasingly mechanism-driven. Catheter ablation, at experienced centers, is effective for late organized tachyarrhythmias, achieving high acute and durable success in recent single-center series. Stroke prevention remains difficult due to changing bleeding risk, organ function, and limited relevant trial evidence. Anticoagulation requires ongoing reassessment. Left atrial appendage occlusion is an emerging alternative for patients ineligible for long-term anticoagulation. Evidence, mainly from registry data and small series, suggests potentially higher vascular complication rates. This review summarizes current knowledge, clarifies knowns and unknowns, and describes future goals, including standardized definitions, phenotyping, surveillance windows, transplant-specific risk stratification, and comparative studies of anticoagulation, ablation, and appendage-closure strategies to improve outcomes.
Core Tip: Post-transplant atrial fibrillation and other atrial tachyarrhythmias are not a uniform postoperative complication. Rather, they form a time-dependent and organ-dependent syndrome with distinct mechanisms and clinical implications across solid-organ transplantation. Thoracic transplantation carries the greatest arrhythmic burden, whereas abdominal transplantation shows a lower incidence but important prognostic consequences. Early atrial fibrillation is usually trigger-mediated, while later atrial arrhythmias often reflect fixed structural substrates, graft-related pathology, or progressive remodeling. Effective management requires a transplant-specific approach that integrates timing, graft status, organ function, drug interactions, thromboembolic risk, bleeding risk, and the growing role of mechanism-guided catheter ablation.
