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

Abstract

Background Supraventricular arrhythmias (SVAs), commonly managed with radiofrequency ablation (RFA), may occur after orthotopic heart transplantation (OHT). Methods We retrospectively assessed 514 consecutive patients (pts.) undergoing OHT between January 1990 and July 2016 in a single‐center. Patients with SVAs managed with RFA were included. Mechanisms of genesis of SVAs, association with surgical techniques and outcomes, were analyzed. Results Of 514 pts undergoing OHT, 53% (272 pts.) were managed with bicaval (BC) technique and 47% (242 pts.) with biatrial (BA) technique. Mean follow‐up 10 ± 8.4 years. Nine pts. (1.7%) developed SVA requiring RFA. The BC technique was performed in 4 pts., 3 pts. presented cavotricuspid isthmus‐dependent atrial flutter (CTI AFL), and 1 pt. double loop AFL. Five pts. were managed with BA technique, 4 pts. presented CTI AFL, and 1 pt. atrial tachycardia (AT). Mean time between OHT and SVA occurrence was 6.6 ± 5.5 years. The procedure was successful in 89% (8 pts.). Arrhythmia recurrence was seen in 3 pts (37%), all with BA technique. Conclusion Supraventricular arrhythmias in heart transplantation may be associated with the surgical scar. Identifying the mechanism is vital to choose the appropriate treatment with radiofrequency ablation.

Frequency, Risk Factors, and Clinical Outcomes of Late-Onset Atrial Flutter in Patients after Heart Transplantation

“…Clinical management of HTX recipients with late-onset post-transplant AFL involves electrical cardioversion, pharmacological cardioversion, catheter ablation, and in some cases conservative treatment due to spontaneous conversion of AFL [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Initial standard treatment of patients with new-onset AFL after HTX predominantly consists of electrical or pharmacological cardioversion [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

“…During the last two decades, treatment and clinical management of HTX recipients with late-onset post-transplant AFL has changed towards a more invasive approach focusing on radiofrequency catheter ablation with three-dimensional electroanatomical mapping systems in order to better understand the underlying mechanisms of post-transplant AFL [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Taylor and colleagues [ 25 ] reported that they treated post-transplant AFL with electrical or pharmacological cardioversion prior to 2002 and started performing catheter ablation for post-transplant AFL hereafter.…”

“…Taylor and colleagues [ 25 ] reported that they treated post-transplant AFL with electrical or pharmacological cardioversion prior to 2002 and started performing catheter ablation for post-transplant AFL hereafter. Several studies demonstrated that catheter ablation is a safe and effective treatment for HTX recipients with post-transplant AFL although the distorted atrial anatomy of the transplanted heart may be challenging regarding optimal catheter placement for ablation of AFL [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”

Keeping It “Current”: A Review of Treatment Options for the Management of Supraventricular Tachycardia

“…49,50 Although less common, SVT may occur in stable OHT patients secondary to atrial flutter and reentry tachycardia due to the proarrhythmic effects of surgical scars. 51,52 Historically, the use of adenosine has been considered a relative contraindication in OHT patients by many experts due to the increased sensitivity of the SA and AV node to sympathomimetic amines secondary to parasympathetic denervation, thus increasing the risk for prolonged AV block. 53 This effect has been demonstrated in clinical studies and has shown a 3-to 5-fold greater response to adenosine.…”

“…49,50 Although less common, SVT may occur in stable OHT patients secondary to atrial flutter and reentry tachycardia due to the proarrhythmic effects of surgical scars. 51,52…”