Bisoprolol prophylaxis was associated with fewer early supraventricular arrhythmias after lung transplantation: a time-dependent cohort analysis

Q: What are the key findings of this study?

Bisoprolol prophylaxis was associated with a lower overall hazard of early in-hospital supraventricular arrhythmia after lung transplantation (adjusted HR 0.14, 95% CI 0.05 to 0.41; p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Lung transplantation (n=470). Intervention: Bisoprolol prophylaxis vs. No qualifying bisoprolol prophylaxis. Primary outcome: First in-hospital supraventricular arrhythmia (atrial fibrillation, atrial flutter, supraventricular tachycardia, or combined AF/AFL) (HR 0.14, 95% CI 0.05 to 0.41, p=<0.001).

Q: What does this research mean for the field?

Bisoprolol prophylaxis is associated with a significantly lower hazard of early in-hospital supraventricular arrhythmias following lung transplantation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between bisoprolol prophylaxis and the risk of early in-hospital supraventricular arrhythmias following lung transplantation.

Pedro José Argos-Vélez; Víctor Manuel Mora Cuesta; David Iturbe Fernandez; Sandra Tello-Mena; Sheila Izquierdo‐Cuervo; Borja Suberviola-Cañas; Laura Sánchez-Moreno; Pilar Alonso‐Lecue; Eduardo Miñambres; María Ángeles Ballesteros-Sanz

doi:10.1136/bmjresp-2026-004819

November 1, 2026BMJ Open Respiratory ResearchOpen Access

Bisoprolol prophylaxis was associated with fewer early supraventricular arrhythmias after lung transplantation: a time-dependent cohort analysis

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Key result

Bisoprolol prophylaxis linked to ~86% lower risk of supraventricular arrhythmia after lung transplantation.

HR 0.14
95% CI 0.05 to 0.41
P<0.001
n=470

Why the study?

Supraventricular arrhythmias are common after lung transplantation, but evidence supporting pharmacological prophylaxis is limited.

Does oral bisoprolol prophylaxis initiated within 30 postoperative days reduce the incidence of early in-hospital supraventricular arrhythmias in lung transplant recipients?

Key Points

To evaluate the association between bisoprolol prophylaxis and the risk of early in-hospital supraventricular arrhythmias following lung transplantation.
Retrospective single-centre cohort study of 470 lung transplant recipients transplanted from 2015 to 2025, excluding patients with early death within 7 days or pre-existing atrial fibrillation.
Qualifying prophylaxis was defined as bisoprolol initiated within 30 postoperative days and before the first supraventricular arrhythmia (183 recipients met this definition).
Assessed first in-hospital atrial fibrillation, atrial flutter, or supraventricular tachycardia using multivariable Cox regression with bisoprolol analysed as a time-dependent exposure.
Overall, 87 recipients (18.5%) developed a supraventricular arrhythmia, and bisoprolol prophylaxis was associated with a lower overall hazard of arrhythmia (adjusted HR 0.14, 95% CI 0.05 to 0.41; p<0.001).
The association was strongest early after transplantation and weakened over time (p=0.014), with adjusted HRs of 0.03 (95% CI 0.003 to 0.27) on day 7 and 0.19 (95% CI 0.05 to 0.70) on day 14.
Potential adverse events occurred in 38 of 201 bisoprolol-treated recipients (18.9%), but serious events were uncommon (2 of 201; 1.0%).

Study Design

Type

Cohort (n=470)

Multicenter

No

Structured PICO

Does oral bisoprolol prophylaxis initiated within 30 postoperative days reduce the incidence of early in-hospital supraventricular arrhythmias in lung transplant recipients?

P

Population

470 consecutive lung transplant recipients (median age 60.4 years, 38.1% female), free of pre-existing atrial arrhythmias and surviving beyond 7 postoperative days, followed until hospital discharge.

E

Exposure

Oral bisoprolol prophylaxis initiated from postoperative day 0 through day 30 inclusive and strictly before the first supraventricular arrhythmia (n=183 qualifying prophylaxis). Among all 201 treated patients, median initiation was day 4 (IQR 3-7) for a median duration of 18 (IQR 7-101.5) days; the most frequent regimen was 1.25 mg every 12 hours (80.6%), followed by 2.5 mg every 12 hours (12.9%).

C

Comparator

No qualifying bisoprolol prophylaxis (n=287 in fixed descriptive analysis; analyzed as unexposed risk time prior to initiation or without qualifying prophylaxis in time-dependent Cox regression).

O

Outcome

First supraventricular arrhythmia (SVA) during the index hospitalisation, defined as composite of atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), or combined AF/AFL documented by 12-lead electrocardiography or continuous monitoring.composite

Main Result

Hazard Ratio: 0.14 (95% CI 0.05–0.41)

Absolute Event Rate: 2.7% vs 28.6%

p-value: p=<0.001

In a time-dependent cohort analysis of 470 lung transplant recipients, postoperative oral bisoprolol prophylaxis was associated with a significantly reduced hazard of early in-hospital supraventricular arrhythmias, particularly during the first two weeks after transplantation.

Limitations

Non-protocolised treatment initiated after haemodynamic stabilisation, leading to residual confounding by clinical status
Unavailable data on vasopressor/inotrope requirements, electrolyte disturbances, volume status, pain, pretransplant echocardiography, and pretransplant medications
Substantial increase in bisoprolol use in later study years alongside baseline differences between groups
Only calendar dates available for treatment initiation and arrhythmia onset
Survivor selection bias due to excluding recipients who died during the first 7 postoperative days
Only five SVA events occurred during bisoprolol-exposed follow-up, resulting in wide confidence intervals
Lack of continuous ECG monitoring on the hospital ward, potentially missing asymptomatic or transient episodes
Retrospective recording of adverse events without systematic assessment in untreated recipients
Single-centre design requiring external validation
Treatment was not protocolised and was usually initiated after haemodynamic stabilisation, creating residual confounding by clinical status.
Information on vasopressor and inotrope requirements, electrolyte disturbances, volume status, pain, detailed pretransplant echocardiographic findings, and pretransplant medication use was unavailable.
Bisoprolol use increased substantially during the later years of the study and prophylaxis groups differed in baseline characteristics.
Excluding recipients who died during the first 7 postoperative days introduced survivor selection bias.
Only five SVA events occurred during bisoprolol-exposed follow-up, resulting in wide time-specific CIs, and continuous ECG monitoring was not available on the hospital ward.

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Implication

May support bisoprolol prophylaxis to reduce early post-lung transplant SVA; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

Background Supraventricular arrhythmias (SVA) are common after lung transplantation (LT) but evidence supporting pharmacological prophylaxis is limited.Methods We retrospectively studied 470 LT recipients transplanted from 2015 to 2025 after excluding early deaths and pre-existing atrial fibrillation. Qualifying prophylaxis was defined as bisoprolol initiated within 30 postoperative days and before the first SVA. The primary outcome was first in-hospital atrial fibrillation, atrial flutter or supraventricular tachycardia. To account for the actual day of treatment initiation, bisoprolol was analysed as a time-dependent exposure in multivariable Cox regression, allowing baseline SVA risk to differ by transplant year.Results Overall, 183 recipients met the prophylaxis definition and 87 (18.5%) developed SVA. Bisoprolol was associated with a lower overall hazard of SVA (adjusted HR 0.14, 95% CI 0.05 to 0.41; p<0.001). The association was strongest early after LT and weakened over time (p=0.014), with adjusted HRs of 0.03 (95% CI 0.003 to 0.27) on day 7 and 0.19 (95% CI 0.05 to 0.70) on day 14. Results were consistent across sensitivity analyses. Potential adverse events occurred in 38 of 201 bisoprolol-treated recipients (18.9%), but serious events were uncommon (2 of 201; 1.0%).Conclusion Bisoprolol prophylaxis was associated with fewer early in-hospital SVA after LT. Prospective studies are required to confirm its efficacy and safety in haemodynamically stable recipients.

Discussion

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Cite This Study

Argos-Vélez et al. (2026) conducted a cohort in Lung transplantation (n=470). Bisoprolol prophylaxis vs. No qualifying bisoprolol prophylaxis was evaluated on First in-hospital supraventricular arrhythmia (atrial fibrillation, atrial flutter, supraventricular tachycardia, or combined AF/AFL) (HR 0.14, 95% CI 0.05 to 0.41, p=<0.001). Bisoprolol prophylaxis was associated with a lower overall hazard of early in-hospital supraventricular arrhythmia after lung transplantation (adjusted HR 0.14, 95% CI 0.05 to 0.41; p<0.001).

synapsesocial.com/papers/6af46d8f7bb3da179b850124 https://doi.org/10.1136/bmjresp-2026-004819

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Bisoprolol prophylaxis was associated with fewer early supraventricular arrhythmias after lung transplantation: a time-dependent cohort analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Bisoprolol prophylaxis was associated with fewer early supraventricular arrhythmias after lung transplantation: a time-dependent cohort analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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