CLINICAL RESEARCH: ARRHYTHMIAS IN CARDIAC TRANSPLANT
Supraventricular Tachycardia After Orthotopic Cardiac Transplantation
Marmar Vaseghi, MD*,
Noel G. Boyle, MD, PhD*,
Rohit Kedia, MD*,
Jignesh K. Patel, MD, PhD ,
David A. Cesario, MD, PhD*,
Isaac Wiener, MD*,
Jon A. Kobashigawa, MD and
Kalyanam Shivkumar, MD, PhD*,*
* UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
UCLA Heart Transplant Program, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
Manuscript received November 19, 2007;
revised manuscript received January 29, 2008,
accepted February 5, 2008.
* Reprint requests and correspondence: Dr. Kalyanam Shivkumar, UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, 47-123 CHS, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, California 90095-1679. (Email: kshivkumar{at}mednet.ucla.edu).
This report was presented in part at the American Heart Association Annual Scientific Sessions, November 9–12, 2003, Orlando, Florida.
Objectives: The purpose of this study was to define the incidence, mechanisms, and management, including catheter ablation, of supraventricular tachycardia (SVT) in a large series of patients after orthotopic heart transplantation (OHT).
Background: Supraventricular arrhythmias are frequently encountered after OHT, but their characteristics in this population have not been well established.
Methods: We analyzed the incidence, clinical course, and management of SVTs in a cohort of 729 adult patients who underwent OHT. Furthermore, the mechanisms of arrhythmias among the patients referred for electrophysiological study (EPS) and ablation were also characterized.
Results: The most common arrhythmia was atrial flutter, which occurred in 9% of this cohort. Persistent or paroxysmal atrial fibrillation occurred in 7%, the majority (57%) in the perioperative period. Persistent or paroxysmal atrial fibrillation was observed in OHT patients, beyond the post-operative period, only in the presence of rejection or transplant vasculopathy. Other persistent or paroxysmal SVTs were seen in 47 stable OHT patients (7%). Of these, 24 patients (4%) underwent EPS. Accessory and dual atrioventricular nodal pathways in the donor heart caused SVT in 3 patients. Macro-reentrant atrial tachycardia was seen in 7 patients, and isthmus-dependent atrial flutter occurred in 14 patients.
Conclusions: The majority of SVTs in stable OHT patients can be attributed to macro-reentrant tachycardias (flutter and scar reentry). Catheter ablation is effective in management of these SVTs. Atrial fibrillation was never encountered in stable patients in our series, and its occurrence should prompt an evaluation for acute rejection and/or vasculopathy.
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | AFL = atrial flutter | | AT = macro-reentrant atrial tachycardia | | AVNRT = atrioventricular nodal reentrant tachycardia | | AVRT = atrioventricular reentrant tachycardia | | EPS = electrophysiological study | | HRV = heart rate variability | | OHT = orthotopic heart transplant | | RFA = radiofrequency ablation | | RMSSD = root-mean-square of successive normal sinus RR interval difference | | SDANN = standard deviation of the averaged normal sinus RR intervals for all 5-min segments | | SDNN = standard deviation of all normal sinus RR intervals over 24 h | | SVT = supraventricular tachycardia |
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J. Am. Coll. Cardiol. 2008 51: A31-A32.
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