Bradycardia and syncope as a presentation of cardiac allograft rejection involving the conducting system

Incidence and predictors of sudden cardiac death after heart transplantation: A systematic review and meta‐analysis

“…Table describes the characteristics of these studies, and Figure shows the risk of SCD. The risk of SCD was significantly higher in patients with post‐transplant lymphoproliferative disorders (15.26 per 100 person‐years, 95% CI: 11.64‐19.76) and those presenting with brady‐arrhythmias (83.33 per 100 person‐years, 95% CI: 27.10‐98.53) . The risk of SCD in other specific populations was similar to the overall post‐transplant population, most of them showing substantial imprecision in estimates.…”

“…Authors rarely reported on the use of ICDs. Two studies mentioned that none of the included recipients had received an ICD post‐transplant. One study reported that 3.4% (10 patients) received a post‐transplant ICD for primary prophylaxis (severe CAV in 8 patients and sustained ventricular tachycardia in 2 patients); two of these (20%) received appropriate device therapy.…”

“…Authors rarely reported on the use of ICDs. Two studies 31,42 The pooled incidence of SCD in studies including contemporary heart transplant recipients was reduced compared to earlier eras, but still 3-fold higher than that in the general population. This decreased rate of SCD could be partly explained by improved patient management.…”

Interventricular conduction disorders after orthotopic heart transplantation: risk factors and clinical relevance

“…Moreover, the association between RBBB and early acute rejection might be underestimated by our retrospective study, as endomyocardial biopsies were obviously not focused on the conduction system, which antigens are different from myocyte antigens and can themselves be targets of rejection. According to this hypothesis, some authors (Knight et al, 2010) described cases of rejection with preferential involvement of the conduction system that can be detected only with post mortem histological analysis. In literature only Osa et al (2000) and Leonelli et al (1996) found a relationship between RBBB and rejection, without any timing difference and defining rejection as the "number of treatable episodes."…”

Coronary Pan-Ischemia as a First Sign of a Fulminant Host-Versus-Graft Reaction Eight Years After Orthotopic Heart Transplantation

“…Several reports suspect transplant rejection to be responsible for arrythmogenic events in patients after heart transplantation, while in other reports autopsy results revealed marked involvement of the conduction system in acute graft rejections. [6][7][8][9][10] In addition, electrophysiological studies in animal models show that the most sensitive parameter of acute rejection is a prolonged atrioventricular conduction time.…”