Increased incidence of atrial flutter associated with the rejection of heart transplantation

Cui, Guanggen; Tung, Thomas; Kobashigawa, Jon A.; Laks, Hillel; Sen, Luyi

doi:10.1016/s0002-9149(01)01641-1

Cited by 64 publications

(76 citation statements)

References 9 publications

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“…In general, focal AT originating from the donor RA has rarely been observed, except for in cases with an atrial insult such as rejection or ischemia. 1,13) This case, however, had normal contraction and no signs of rejection including any cell-mediated immunity or humoral immunity, vasculopathy judged by coronary angiography and an intravascular ultrasound analysis, or infection.…”

Section: Discussionmentioning

confidence: 88%

Catheter Ablation of Focal Atrial Tachycardia Originating From a Donor Heart After Bicaval Orthotopic Heart Transplantation Guided by a Noncontact Mapping System

et al. 2012

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SummaryA 19-year-old man who underwent bicaval orthotopic heart transplantation for idiopathic dilated cardiomyopathy complained of palpitations 2 weeks after the heart transplantation. An ECG revealed paroxysmal atrial tachycardia (AT) with a cycle length of 260 ms and the P wave morphology of the AT was similar to that during sinus rhythm. Echocardiography showed normal contraction. No rejection, vasculopathy, or infection was observed. An electrophysiologic study and catheter ablation guided by a noncontact mapping system were performed due to drug refractory AT. The AT was induced spontaneously by isoproterenol infusion. The activation sequence of the AT exhibited a focal pattern, and the breakout site of the AT into the donor right atrium was just 12 mm below the breakout site of the donor sinoatrial node. Radiofrequency catheter ablation eliminated this AT and resulted in an improvement in the symptoms. (Int Heart J 2012; 53: 146-148) Key words: Atrial tachycardia, Bicaval orthotopic heart transplantation, Catheter ablation, Noncontact mapping system O rthotopic heart transplantation is an established and effective therapy for end-stage heart disease. The bicaval anastomosis method better preserves normal right atrial anatomy and function, may minimize any sinoatrial (SA) node trauma, and minimizes the tachyarrhythmia events. However, we present here an interesting case in which paroxysmal focal AT originating from the donor RA was observed without any rejection, vasculopathy, or infection during the subacute phase after bicaval orthotopic heart transplantation and was successfully ablated guided by a noncontact mapping system. Case ReportA 19-year-old man underwent a bicaval orthotopic heart transplant for idiopathic dilated cardiomyopathy. He had received immunosuppressant drugs and steroid therapy. He began complaining of palpitations 2 weeks after the transplant. An ECG revealed paroxysmal atrial tachycardia (AT) ( Figure 1). The AT exhibited a sudden onset with physical activity and sudden termination. The morphology of the AT exhibited positive P waves in leads II, III, and aVF and was biphasic in lead V1. Echocardiography revealed normal contractions and there were no signs of rejection, vasculopathy, or infection. An electrophysiologic study and catheter ablation were performed due to AT refractory to drugs such as bisoprolol and verapamil. The AT was not induced by programming stimulation, however, an AT with a cycle length of 260 ms was spontaneously induced during isoproterenol infusion and was consistent with the clinical AT. The P wave of the AT was similar to that during sinus rhythm and overdrive atrial pacing and infusion of adenosine transiently suppressed the tachycardia (Figure 2). An Ensite Array was inserted into the right atrium (RA) and its geometry was created. The AT terminated while creating the RA geometry, however, the virtual activation sequence of the AT was recorded by the noncontact mapping system. The acti- vation sequence of the AT exhibited a focal pattern and the b...

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Section: Discussionmentioning

confidence: 88%

Catheter Ablation of Focal Atrial Tachycardia Originating From a Donor Heart After Bicaval Orthotopic Heart Transplantation Guided by a Noncontact Mapping System

et al. 2012

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“…Khan et al 1 did not find any association with rejection, but the Cui et al 17 study yielded a clear link when mild rejection (Grade 1-2 of the International Society for Heart and Lung Transplantation classification 18 ) was also considered. In contrast to AF, no study has shown increased mortality in OHT patients experiencing AFL.…”

Section: Clinical Perspectivementioning

confidence: 96%

Arrhythmias in the Heart Transplant Patient

Hamon

Taleski

Vaseghi

et al. 2014

Arrhythm Electrophysiol Rev

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Orthotopic heart transplantation (OHT) is the most effective long-term therapy for end-stage heart disease, with implanted left ventricular assist devices ('destination therapy') as an alternative for selected patients. The denervation of the transplanted heart with complete loss of autonomic nervous system modulation, the use of immunosuppressant drugs, as well as the risk of allograft rejection (AR) and vasculopathy, all change the incidence, prognosis and treatment of tachyarrhythmias and bradyarrhythmias, as well as the mechanisms of sudden cardiac death (SCD).Arrhythmias post-OHT can be classified according to their underlying mechanisms (see Table 1). Tachyarrhythmias and bradyarrythmias can come from the transplanted heart, be due to the surgery itself or result from AR or vasculopathy. In addition, bradyarrhythmias may be caused by drugs taken by the recipient patient before surgery. This review aims to present the most common causes of arrhythmias in OHT patients, and to highlight the importance of ruling out and treating AR and vasculopathy -transplant coronary artery disease (TCAD), which should always be the first concern. The causative mechanisms represent different risk factors, and overlap is possible, which may increase the occurrence of such arrhythmias.With the increasing success of radiofrequency (RF) ablation techniques, it is important that cardiologists are familiar with tachycardias and bradycardias in this context, which may benefit from a multidisciplinary approach in the management of the patient starting with the underlying mechanisms. Tachyarrhythmias Supraventricular TachycardiaThe most common atrial arrhythmia in OHT patients is atrial flutter AbstractOrthotopic heart transplantation (OHT) is currently the most effective long-term therapy for patients with end-stage cardiac disease, even as left ventricular devices show markedly improved outcomes. As surgical techniques and immunosuppressive regimens have been refined, short-term mortality caused by sepsis has decreased, while morbidity caused by repeated rejection episodes and vasculopathy has increased, and is often manifested by arrhythmias. These chronic transplant complications require early and aggressive multidisciplinary treatment. Understanding the relationship between arrhythmias and these complications in the acute and chronic stages following OHT is critical in improving patient prognosis, as arrhythmias may be the earliest or sole presentation. Finally, decentralised/ denervated hearts represent a unique opportunity to investigate the underlying mechanisms of arrhythmias.

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“…Фибрилляция предсердий оказы-вается одной из наиболее часто встречающихся тахиаритмий у пациентов после трансплантации сердца. По данным различных авторов, частота фибрилляции предсердий у реципиентов донор-ского сердца составляет от 0,3 до 24% [2][3][4]. Столь …”

Section: эпидемиологияunclassified

“…Отсутствие воздействия цен-тральных нервных влияний на функцию алло-графта, а также хирургическая изоляция легоч-ных вен, которая происходит в рамках транс-плантации, позволяют подтвердить гипотезу о том, что фибрилляция предсердий после транс-плантации сердца является индикатором патоло-гических изменений миокарда ишемического или иммунологического генеза, а также неадекват-ного нейрогуморального фона. Ряд исследований [3, 7- Наиболее частыми факторами, обусловливаю-щими развитие данной аритмии в раннем после-операционном периоде, являются механическое воздействие на сердце, перикардит, использова-ние инотропных препаратов в периоперационном периоде, нарушение баланса автономной нервной системы и реакция отторжения аллографта [2,4].…”

Section: классификацияunclassified