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

Ferretto, Sonia; Tafciu, Elvin; Giuliani, Immacolata; Feltrin, Giuseppe; Bottio, Tomaso; Gambino, Antonio; Fraiese, Angela; Iliceto, Sabino; Gerosa, Gino; Leoni, Loira

doi:10.1111/anec.12402

Cited by 10 publications

(29 citation statements)

References 14 publications

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“…11 RBBB is a frequently reported abnormality after orthotopic heart transplant, with reported incidence from 14% to 69%. [12][13][14] In our study, 52% of patients had RBBB. However, the clinical significance is controversial.…”

Section: Discussionmentioning

confidence: 44%

“…In most studies, researchers found no association between RBBB and adverse outcomes. [12][13][14][15] To our knowledge, a relationship between RBBB and rejection has been reported in only 3 studies, 13,16,17…”

Section: Discussionmentioning

confidence: 92%

“…but differences in definitions and relatively small sample sizes warrant caution in generalizing the results. Ferretto et al 13 found an association between development of RBBB and early acute graft rejection; they converted the 1990 International Society of Heart and Lung Transplantation grading into points and defined rejection as a score of at least 2 points (grade 1B). The new International Society of Heart and Lung Transplantation grading of 2R for moderate rejection, as used in our study, is comparable to a grade of 3A in the old system, which limits comparisons with the study by Ferretto et al We had 280 episodes of mild rejection, which trended toward significance in an association with RBBB (P = .07).…”

mentioning

confidence: 99%

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Electrocardiographic Correlates of Acute Allograft Rejection Among Heart Transplant Recipients

Hickey¹,

Sciacca²,

Chen³

et al. 2018

Am J Crit Care

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Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

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Electrocardiographic Correlates of Acute Allograft Rejection Among Heart Transplant Recipients

Hickey¹,

Sciacca²,

Chen³

et al. 2018

Am J Crit Care

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“…Since the right bundle branch has a unique anatomical structure, it might be susceptible to damage during HT: much of its septal course is near the endocardium and consists of narrow cylindrical tubes 17. Also, biatrial anastomosis and clockwise rotation of a transplanted heart, as a result of the surgical technique, could be other causative factors for RBBB 1151819. Considering these factors, our study indicated that the occurrence of RBBB early within 1 month following HT was less likely to be related with early graft rejection.…”

Section: Discussionmentioning

confidence: 71%

“…The prevalences of RBBB in the present study population were 15.9% at 1 month and 36.5% at 1 year, similar to previous studies (12% to 79%). Most previous studies reported that the development of RBBB and QRS width increased over the time after HT 4131415. Meanwhile, several studies indicated that the occurrence of conduction disorders after HT was related with longer ischemic time, extracorporeal circulation time, surgery-related myocardial damage, and graft rejection 3416.…”

Section: Discussionmentioning

confidence: 99%

Association of Newly Developed Right Bundle Branch Block with Graft Rejection Following Heart Transplantation

Kim

et al. 2019

Yonsei Med J

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Purpose We aimed to examine associations between right bundle branch block (RBBB) following heart transplantation (HT) and graft rejection. Materials and Methods We investigated 51 patients who underwent endomyocardial biopsies, electrocardiogram, right-side cardiac catheterization, and echocardiography at 1 month and 1 year after HT. We classified patients into four groups according to the development of RBBB, based on electrocardiogram at 1 month and 1 year: 1) sustained RBBB, 2) disappeared RBBB, 3) newly developed RBBB, and 4) sustained non-RBBB. The RBBB was defined as an RSR' pattern in V1 with a QRS duration ≥100 ms on electrocardiogram. Results The newly developed RBBB group (n=13, 25.5%) had a higher rate of new onset graft rejection (from grade 0 to grade ≥1R, 30.8% vs. 10.0% vs. 21.4%, p =0.042) at 1 year, compared with sustained RBBB (n=10, 19.6%) and sustained non-RBBB group (n=28, 54.9%). In contrast, the incidence of resolved graft rejection (from grade ≥1R to grade 0) was higher in the sustained RBBB group than the newly developed RBBB and sustained non-RBBB groups (70.0% vs. 7.7% vs. 25.0%, p =0.042). Left atrial volume index was significantly higher in the newly developed RBBB group than the sustained RBBB and sustained non-RBBB groups (60.6±25.9 mL/m 2 vs. 36.0±11.0 mL/m 2 vs. 38.4±18.1 mL/m 2 , p =0.003). Conclusion Close monitoring for new development of RBBB at 1 year after HT, which was associated with a higher incidence of new onset graft rejection, may be helpful to identify high risk patients for graft rejection.

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Newly acquired complete right bundle branch block early after heart transplantation is associated with lower survival

et al. 2021

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Aims Right bundle branch block (RBBB) after heart transplantation (HTX) is a common finding, but its impact on post-transplant survival remains uncertain. This study investigated the post-transplant outcomes of patients with complete RBBB (cRBBB) ≤ 30 days after HTX. Methods This registry study analysed 639 patients receiving HTX at Heidelberg Heart Center between 1989 and 2019. Patients were stratified by diagnosis of cRBBB ≤ 30 days after HTX. Analysis included recipient and donor data, medication, echocardiographic features, graft rejections, atrial fibrillation, heart rates, permanent pacemaker implantation and mortality after HTX including causes of death. Results One hundred thirty-nine patients showed cRBBB ≤ 30 days after HTX (21.8%), 20 patients with pre-existing cRBBB in the donor heart (3.2%) and 119 patients with newly acquired cRBBB (18.6%). Patients with newly acquired cRBBB had a worse 1-year post-transplant survival (36.1%, P < 0.01) compared with patients with pre-existing cRBBB (85.0%) or without cRBBB (86.4%), along with a higher percentage of death due to graft failure (P < 0.01). Multivariate analysis indicated cRBBB ≤ 30 days after HTX as significant risk factor for 1-year mortality after HTX (HR: 2.20; 95% CI: 1.68-2.87; P < 0.01). Secondary outcomes showed a higher rate of an enlarged right atrium (P = 0.01), enlarged right ventricle (P < 0.01), reduced right ventricular function (P < 0.01), 30-day atrial fibrillation (P < 0.01) and 1-year permanent pacemaker implantation (P = 0.02) in patients with cRBBB after HTX. Conclusions Newly acquired cRBBB early after HTX is associated with increased post-transplant mortality.

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

Abstract: RBBB is the most common IVCD. Its presence can be explained by a susceptibility of the right branch to heart positioning, pressure overload, and acute rejection. IVCDs do not affect prognosis.

Cited by 10 publications

References 14 publications

Electrocardiographic Correlates of Acute Allograft Rejection Among Heart Transplant Recipients

Electrocardiographic Correlates of Acute Allograft Rejection Among Heart Transplant Recipients

Association of Newly Developed Right Bundle Branch Block with Graft Rejection Following Heart Transplantation

Newly acquired complete right bundle branch block early after heart transplantation is associated with lower survival

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