What Is the Mechanism of the Atrial Arrhythmia in a Patient After Orthotopic Heart Transplantation?

Abstract

Atrial arrhythmias are quite common in patients after heart transplantation; they can occur via focal or reentrant mechanisms and are amenable to curative therapy with catheter ablation. Integration of the individual patient's surgical anatomy with the arrhythmia pattern on 12-lead electrocardiogram can help both to narrow the potential arrhythmia diagnoses and to facilitate therapeutic decision making. This case highlights the differential diagnosis and management of such a patient.

Atrial fibrillation following heart transplantation: A systematic review and meta‐analysis of observational studies

“…Both abnormal automaticity and reentry is the major mechanism of AF development. Second, a recipient to donor atrioatrial conduction may be a focus of AF via conduction across suture lines . In addition, AF that occurs during the early perioperative period, especially within 2 weeks after heart transplantation, is associated with acute graft rejection .…”

Arrhythmias After Heart Transplantation: Mechanisms and Management

“…In combination with graft P waves, the native P waves may mimic atrial flutter, though close examination will reveal nonconducted atrial parasystole rather than atrial flutter . Reestablishment of conduction across the atrial anastomosis may produce tachycardia because of fibrillatory activity or flutter activity in the recipient atrium . Sinus activity from the recipient atrium may intermittently escape into the donor atrium and manifest as frequent atrial ectopics or an atrial parasystole.…”

“…7 Reestablishment of conduction across the atrial anastomosis may produce tachycardia because of fibrillatory activity or flutter activity in the recipient atrium. [8][9][10][11][12] Sinus activity from the recipient atrium may intermittently escape into the donor atrium and manifest as frequent atrial ectopics or an atrial parasystole. The scars in the atria act as conduction barriers and can also predispose to atrial flutters-cavo-tricuspid isthmus dependent as well as mitral annular flutters.…”

Atrial arrhythmia in a patient after bicaval heart transplantation: Evidence for recipient-to-donor conduction

“…3 To our knowledge, several cases described AF in the recipient atrium after transplantation, which resulted in atrial tachycardia or atrial flutter in the donor heart. [6][7][8][9] In all of them, electroanatomical mapping was used to identify and treat the atrio-atrial conduction sites, resulting in restoring sinus rhythm in the donor heart, and suggesting a recipientto-donor conduction.…”