Atrial flutter in the recipient atrium induced by premature beats arising from the donor atrium 10 years after orthotopic heart transplantation

Abstract

Symptomatic arrhythmias in patients after heart transplantation can indirectly originate from the donor atrium via bidirectional recipient-donor atrial conduction. This type of arrhythmia can be successfully treated with radiofrequency ablation.

Catheter Ablation of Atrial Flutter after Orthotopic Heart Transplantation

“…The flutter circuit in the transplanted heart frequently involves the isthmus between the surgical right atrial anastomosis and the TV as part of its circuit 4 . Whether the frequency of atrial flutter in the transplant population is due to the effects of rejection on the myocardial substrate, narrowing and/or modification of this isthmus, 6 surgical suture lines within the atria, electrical connections between donor and recipient atria, 7,10 autonomic changes in the denervated heart, or the myriad of physiologic changes associated with heart transplant has not yet been elucidated. What is clear, however, is that atrial flutter is common in the transplanted heart and has been successfully ablated in the majority of reported cases by creating electrical block across this isthmus.…”

“…This study suggested a flutter circuit involving macroreentry around the tricuspid annulus, but the study did not involve detailed electroanatomic mapping of the flutter circuit or ablation of the arrhythmia in the patients. Publications describing successful atrial flutter ablation in transplanted hearts have been limited to single case reports 5–12 . Here we describe detailed electroanatomic mapping and radiofrequency catheter ablation in three patients with right atrial flutter that occurred 8 to 10 years after orthotopic heart transplantation.…”

Orthotopic heart transplantation: two parts of the heart with two different arrhythmias

“…Atrial arrhythmias are common and well documented after successful orthotopic heart transplantation [1][2][3][4]. New anatomical barriers due to heart transplantation surgery support the creation of macro-reentrant arrhythmias in the atria [3].…”

“…Atrial arrhythmias are common after orthotopic heart transplantation [1][2][3][4]. Atrial tachycardia or atrial flutter (AFl) originating from the recipient heart is well documented [3][4].…”

Radiofrequency ablation of supraventricular arrhythmias after orthotopic heart transplantation: Long‐term follow‐up of a single‐center experience

“…Case series reported in recent studies show an incidence ranging from 4% to 40% 8,9 . A variety of SVAs linked with long‐term follow‐up of patients receiving OHT has been described, including atrial fibrillation (AF), atrial flutter (AFL) in both the recipient atrium and the donor atrium, focal automatic atrial tachycardia (AT), dual AV nodal reentrant tachycardia, or presence of an accessory electrical pathway in the donor atrium 10‐15 . The prognostic impact of SVAs has not yet been determined.…”