ECG diagnosis of native heart ventricular tachycardia in a heterotopic heart transplant recipient

Abstract

A case is reported of haemodynamic collapse in a 51 year old male heterotopic heart transplant recipient caused by native heart ventricular tachycardia. An accurate diagnosis was made by selective right and left sided electrocardiography. Synchronised electrical cardioversion of the native heart (200 J) resulted in restoration of sinus rhythm with prompt relief of symptoms and amelioration of the clinical situation. (Heart 1999;81:323-324) Keywords: transplantation; ventricular tachycardia A 51 year old man underwent heterotopic heart transplantation because of end stage ischaemic heart disease and fixed pulmonary hypertension. Two days after transplantation he was admitted to the intensive care unit because of sudden haemodynamic collapse. His clinical course had been uneventful, but he presented with cardiogenic shock characterised by hypotension (blood pressure 55/46 mm Hg), severe respiratory distress, and a rapid irregular heart rate of approximately 150 beats/min.The 12 lead ECG (fig 1) showed a broad QRS complex tachycardia with a left bundle branch block morphology at a rate of 245 beats/min. According to the standard ECG criteria 1 he was diagnosed with ventricular tachycardia; however, the exact nature of the tachycardia remained obscure as narrow QRS complexes were interposed between the broad ones in the peripheral limb leads. Although these narrow beats during ventricular tachycardia could result from capture or echo beats, they most probably reflected normal activation of the non-aVected heart. We wondered from which heart-donor or host-the arrhythmia originated. In contrast to the left precordial leads (V2-6), the precordial V1 lead showed sinus tachycardia; therefore an ECG in the dextrocardia position was taken by positioning the precordial leads rightwards on the chest. This right sided ECG showed ventricular tachycardia in V1R whereas precordial leads V2R-6R showed sinus rhythm (fig 1). As the donor heart is positioned rightward to the

Stable Ventricular Fibrillation in a Heterotopic Heart Transplant Recipient

“…To date, with the improvements in immunosuppressive therapy, it is generally reserved to a specific subset of conditions such as donor scarcity, difficulties in matching sizes (major donor-recipient body-size mismatch >30%) [3] or in patients suffering from severe pulmonary hypertension. In this setting, in fact, orthotopic heart transplantation is generally denied since the thin walled right ventricle of the donor heart will not be able to sustain the sudden increase in the right ventricular afterload imposed by the high pulmonary circulation pressure [4].…”

Double rhythm in double heart

“…The standard ECG shows the native heart better, while right modified leads give information about the donor heart [2,3]. It is possible that only one of the two hearts (most frequently the native one) has serious arrhythmias [4][5][6].…”

Catheter Ablation of Recipient Right Ventricular Tachycardia after Heterotopic Heart Transplantation

“…This case report brings information regarding ablation of VT after heterotopic HT. First, as mentioned in previous reports, 4–6 it is important to identify which heart is a source of VT. In the present case, surface ECG suggested that VT originated from the recipient heart.…”

“…Yet, various arrhythmias may occur after both types of surgery. While most of the previous reports dealt with supraventricular tachycardias after orthotopic HT, few mentioned arrhythmias following heterotopic HT 1–6 . To the best of our knowledge, ablation of ventricular tachycardia (VT) from the recipient heart after heterotopic HT has not been published.…”