Atrial flutter after orthotopic heart transplantation

Recipient Atrial Flutter Masquerading as Donor Flutter in a Heart Transplant Recipient

“…The intracardiac recordings in our case show dissociated electrical activity in the donor and recipient atria. This dissociation has been reported previously by Kautzner et al, 16 who found that the recipient's atrium was in atrial fibrillation and the donor's atrium was in atrial flutter, which was ablated. Although we did not use electro-anatomic mapping to further study the macro-reentrant circuit, the intracardiac recordings and donoratrial pacing clearly demonstrate that the flutter appearing on the surface ECG involved the recipient atrial remnant, which was electrically dissociated from the donor.…”

Arrhythmias After Heart Transplantation: Mechanisms and Management

“…When sustained atrial flutter occurs after HT, radiofrequency ablation is a viable option after primary etiologies such as acute rejection, LV dysfunction, and cardiac ischemia have been excluded. The altered anatomy of the transplanted heart often makes catheter placement challenging for ablation of right atrial isthmus flutter . Mitral isthmus flutter can be ablated using standard techniques used in the non‐HT context.…”

“…15,25 Typical isthmus-dependent flutters may be easily identified, but atypical macroreentrant tachycardia may be difficult to differentiate from ectopic atrial tachycardia in the donor heart or atrial activity conducted from the recipient atrium when the biatrial method is used. 53,54 Risk of atrial flutter is increased by use of the biatrial method and older donor age. 27 Patients with atrial flutter are more likely to have LV dysfunction and earlier mortality.…”

“…The altered anatomy of the transplanted heart often makes catheter placement challenging for ablation of right atrial isthmus flutter. 53,55 Mitral isthmus flutter can be ablated using standard techniques used in the non-HT context.…”