Efficacy and Safety of Catheter Ablation for Atrial Arrhythmias in Solid Organ Transplant Recipients: A Single‐Center Experience

INTRODUCTION: Atrial arrhythmias are common among solid organ transplant recipients and independently associated with increased morbidity, mortality, and impaired graft survival. Pharmacological management is substantially limited by interactions with immunosuppressive therapy. Despite growing clinical need, data on the feasibility, safety, and efficacy of catheter ablation in this population remain scarce. METHODS: Single-center, retrospective, matched cohort study. All consecutive solid organ transplant recipients who underwent catheter ablation of symptomatic left atrial arrhythmias between July 2021 and June 2024 were included. Each was matched 1:2 to non-transplant controls by age, sex, BMI, arrhythmia type, and ablation modality. All procedures were performed using contemporary techniques: pulsed field ablation (PFA) or very high-power short-duration (vHPSD) radiofrequency ablation. RESULTS: Sixty-six patients were included: 22 transplant recipients and 44 matched controls. Arrhythmia-free survival at 12 months after a 2-month blanking period was 68.2% versus 76.2% (p = 0.49; HR 1.57, 95% CI 0.60-4.12). Periprocedural complications occurred in 9.1% versus 4.6% (p = 0.60); no cases of stroke, cardiac tamponade, or access site complications requiring surgical intervention were recorded in either group. In the kidney transplant subgroup (n = 17), eGFR remained stable at 12 months (41.8 ± 12.1 vs. 43.8 ± 15.3 mL/min/1.73 m², p = 0.34), with no clinically significant decline in renal function observed. CONCLUSION: Catheter ablation for complex atrial arrhythmias in solid organ transplant recipients was feasible using contemporary ablation techniques, without major procedural complications, and no excess safety or efficacy signal was observed at 12 months relative to matched controls. Prospective multicentre studies are needed to confirm these observations.