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Nag T, Jacobson J. Radiofrequency ablation of atrioventricular nodal reentrant tachycardia in an orthotopic heart transplantation patient. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1684-1686. [DOI: 10.1111/pace.13466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Tonusri Nag
- Cardiology Division, Department of Medicine, New York Medical College; Westchester Medical Center; Valhalla New York
| | - Jason Jacobson
- Cardiology Division, Department of Medicine, New York Medical College; Westchester Medical Center; Valhalla New York
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52
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Wdowczyk J, Makowiec D, Gruchała M, Wejer D, Struzik ZR. Dynamical Landscape of Heart Rhythm in Long-Term Heart Transplant Recipients: A Way to Discern Erratic Rhythms. Front Physiol 2018; 9:274. [PMID: 29686620 PMCID: PMC5900061 DOI: 10.3389/fphys.2018.00274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/08/2018] [Indexed: 12/26/2022] Open
Abstract
It is commonly believed that higher values of heart rate variability (HRV) indices account for better organization of the network of feedback reflexes driving an organism's response to actual bodily needs. In order to evaluate this organization in heart transplant (HTX) recipients, 58 nocturnal Holter signals of 14 HTX patients were analyzed. Their dynamical properties were evaluated by short-term HRV indices and measures grounded on entropy. Estimates grouped according to the patients' clinical progress: free of complications versus with complications, and arranged in order of the length of time since the HTX, lead us to the conclusion that higher HRV is associated with a worse outcome for HTX patients. Moreover, short-term HRV indices that are constant, rather than increasing over time, serve well in the prognosis of the future state of a HTX patient. These findings suggest that increases observed in HRV indices are related to erratic rhythms resulting from remodeling of the cardiac tissue (including heterogeneous innervation) in long-term HTX patients. Therefore, we hypothesize that dynamical landscape markers (entropy and fragmentation measures together with the short-term HRV indices) can serve as a tool in the exploration of the genesis of (non-respiratory sinus) arrhythmia.
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Affiliation(s)
- Joanna Wdowczyk
- First Cardiology Clinic, Medical University of Gdańsk, Gdańsk, Poland
| | - Danuta Makowiec
- Faculty of Mathematics, Physics and Informatics, Institute of Theoretical Physics and Astrophysics, University of Gdańsk, Gdańsk, Poland
| | - Marcin Gruchała
- First Cardiology Clinic, Medical University of Gdańsk, Gdańsk, Poland
| | - Dorota Wejer
- Faculty of Mathematics, Physics and Informatics, Institute of Experimental Physics, University of Gdańsk, Gdańsk, Poland
| | - Zbigniew R Struzik
- Laboratory for Advanced Brain Signal Processing, RIKEN Brain Science Institute, Wako, Japan.,Graduate School of Education, University of Tokyo, Tokyo, Japan
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Alba AC, Foroutan F, Ng Fat Hing NKV, Fan CPS, Manlhiot C, Ross HJ. Incidence and predictors of sudden cardiac death after heart transplantation: A systematic review and meta-analysis. Clin Transplant 2018; 32:e13206. [DOI: 10.1111/ctr.13206] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ana C. Alba
- Heart Failure and Transplantation Program; Toronto General Hospital; University Health Network; Toronto ON Canada
| | - Farid Foroutan
- Heart Failure and Transplantation Program; Toronto General Hospital; University Health Network; Toronto ON Canada
| | | | - Chun-Po S. Fan
- The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Cedric Manlhiot
- The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Heather J. Ross
- Heart Failure and Transplantation Program; Toronto General Hospital; University Health Network; Toronto ON Canada
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54
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Paroxysmal bradyarrhythmias are frequent among heart transplant recipients with unexplained syncope: a study based on implantable loop recorders. Eur J Heart Fail 2017; 20:616-618. [DOI: 10.1002/ejhf.1102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/09/2017] [Accepted: 11/10/2017] [Indexed: 11/07/2022] Open
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Abstract
We present a 21-year-old woman status post orthotopic heart transplantation initially presenting with a regular narrow complex tachycardia at 159beats/min. With intravenous diltiazem the rhythm transitioned to a regular tachycardia at 106beats/min, 2/3rd of the initial heart rate. We demonstrate this to be a novel description of 3:2second-degree Mobitz type I atrioventricular block (Wenckebach) with the absence of the hallmark regularly irregular (grouped beating) pattern.
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56
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Li Y, Zeng Q, Liu G, Du J, Gao B, Wang W, Zheng Z, Hu S, Ji B. Development and Evaluation of Heartbeat: A Machine Perfusion Heart Preservation System. Artif Organs 2017; 41:E240-E250. [PMID: 28800676 DOI: 10.1111/aor.12867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/18/2016] [Accepted: 08/26/2016] [Indexed: 12/11/2022]
Abstract
Static cold storage is accompanied with a partial safe ischemic interval for donor hearts. In this current study, a machine perfusion system was built to provide a better preservation for the donor heart and assessment for myocardial function. Chinese mini-swine (weight 30-35 kg, n = 16) were randomly divided into HTK, Celsior, and Heartbeat groups. All donor hearts were respectively preserved for 8 hours under static cold storage or machine perfusion. The perfusion solution is aimed to maintain its homeostasis based on monitoring the Heartbeat group. The ultrastructure of myocardium suggests better myocardial protection in the Heartbeat group compared with HTK or Celsior-preserved hearts. The myocardial and coronary artery structural and functional integrity was evaluated by immunofluorescence and Western blots in the Heartbeat. In the Heartbeat group, donor hearts maintained a high adenosine triphosphate level. Bcl-2 and Beclin-1 protein demonstrates high expression in the Celsior group. The Heartbeat system can be used to preserve donor hearts, and it could guarantee the myocardial and endothelial function of hearts during machine perfusion. Translating Heartbeat into clinical practice, it is such as to impact on donor heart preservation for cardiac transplantation.
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Affiliation(s)
- Yongnan Li
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Qingdong Zeng
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Gang Liu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Junzhe Du
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Wei Wang
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhe Zheng
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Figueroa-Bohórquez DM, Benavides X, Garzón L, Espinel D, Suarez L, Uribe M, Gómez-Aristizabal L, Lozano Márquez E. Electrocardiographic alterations associated with heart transplantation. Triggers, mechanisms and meaning. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n3.57498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Las alteraciones del ritmo cardíaco están asociadas con un aumento en la morbimortalidad; sin embargo, en pacientes con trasplante cardíaco no son claros sus desencadenantes ni implicaciones.Objetivos. Realizar una búsqueda en la literatura para identificar y explicar los determinantes en la generación de alteraciones de la conducción eléctrica en pacientes con trasplante cardíaco, así como describir las principales arritmias que pueden presentarse, explicando sus implicaciones patológicas.Materiales y métodos. Se realizó una búsqueda en la base de datos PubMed que arrojó un total de 411 resultados. Además, se buscaron las guías de práctica clínica sobre trasplante cardíaco, electrofisiología cardiovascular y endocarditis infecciosa. Se eligieron 60 artículos que lograban responder a los objetivos de este estudio.Resultados. La técnica quirúrgica, la denervación cardíaca, las lesiones del nodo sinusal, el rechazo del injerto, las biopsias endomiocárdicas y las infecciones son los principales factores que comprometen la viabilidad del órgano y la vida del paciente trasplantado, manifestándose como alteraciones del ritmo sinusal.Conclusiones. Ante la detección de alguna arritmia cardíaca, el equipo médico debe proporcionar un manejo que no se limite al control sintomático y del ritmo sinusal, sino que se debe iniciar una búsqueda activa de su etiología, ya que esta puede ser la manifestación de un proceso patológico subyacente.
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58
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Rivinius R, Helmschrott M, Ruhparwar A, Erbel C, Gleissner CA, Darche FF, Thomas D, Bruckner T, Katus HA, Doesch AO. The influence of surgical technique on early posttransplant atrial fibrillation - comparison of biatrial, bicaval, and total orthotopic heart transplantation. Ther Clin Risk Manag 2017; 13:287-297. [PMID: 28331331 PMCID: PMC5352240 DOI: 10.2147/tcrm.s126869] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Early posttransplant atrial fibrillation (AF) has been associated with worse clinical outcomes after heart transplantation (HTX). The type of surgical technique may constitute a relevant risk factor for AF. PATIENTS AND METHODS This retrospective single-center study included 530 adult patients. Patients were stratified by surgical technique (biatrial, bicaval, or total orthotopic HTX) and early posttransplant heart rhythm (AF or sinus rhythm). Univariate and multivariate analyses were performed to evaluate risk factors for AF. RESULTS A total of 161 patients received biatrial HTX (30.4%), 115 bicaval HTX (21.7%), and 254 total orthotopic HTX (47.9%). Sixty-one of 530 patients developed early posttransplant AF (11.5%). Patients with AF showed a statistically inferior 5-year survival compared to those with sinus rhythm (P<0.0001). Total orthotopic HTX had the lowest rate of AF (total orthotopic HTX [6.3%], bicaval HTX [14.8%], biatrial HTX [17.4%], P=0.0012). Multivariate analysis showed pretransplant valvular heart disease (P=0.0372), posttransplant enlarged left atrium (P=0.0066), posttransplant mitral regurgitation (P=0.0370), and non-total orthotopic HTX (P=0.0112) as risk factors for AF. CONCLUSION Early posttransplant AF was associated with increased mortality (P<0.0001). Total orthotopic HTX showed the lowest rate of AF compared to biatrial or bicaval HTX (P=0.0012).
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Affiliation(s)
| | | | | | | | | | | | - Dierk Thomas
- Department of Cardiology, Angiology and Pneumology
| | - Tom Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology
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59
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WELLMANN PETRA, HERRMANN FLORIANERNSTMARTIN, HAGL CHRISTIAN, JUCHEM GERD. A Single Center Study of 1,179 Heart Transplant Patients-Factors Affecting Pacemaker Implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:247-254. [DOI: 10.1111/pace.13021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/16/2016] [Accepted: 01/02/2017] [Indexed: 11/28/2022]
Affiliation(s)
- PETRA WELLMANN
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | | | - CHRISTIAN HAGL
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | - GERD JUCHEM
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
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60
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Non-cardiac Surgery After Heart Transplantation. Anesthesiology 2017. [DOI: 10.1007/978-3-319-50141-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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61
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Martens T, Caes F, De Pauw M, Hens L, Bove T. Minimally Invasive Repair of Mitral Valve Prolapse and Concomitant Atrial Fibrillation Ablation in a Heart Transplant. Ann Thorac Surg 2016; 102:e305-7. [PMID: 27645968 DOI: 10.1016/j.athoracsur.2016.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/14/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
Abstract
Significant mitral valve disease with atrial fibrillation after heart transplantation is unusual. We report the diagnosis and minimally invasive surgical treatment 17 years after transplantation, in which mitral valve repair together with left atrial ablation was performed, resulting in a satisfying clinical and echocardiographic improvement.
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Affiliation(s)
- Thomas Martens
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Frank Caes
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Lineke Hens
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
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62
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Acampa M, Lazzerini PE, Guideri F, Tassi R, Martini G. Ischemic Stroke after Heart Transplantation. J Stroke 2016; 18:157-68. [PMID: 26915504 PMCID: PMC4901943 DOI: 10.5853/jos.2015.01599] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/13/2015] [Accepted: 01/04/2016] [Indexed: 12/16/2022] Open
Abstract
Cerebrovascular complications after orthotopic heart transplantation (OHT) are more common in comparison with neurological sequelae subsequent to routine cardiac surgery. Ischemic stroke and transient ischemic attack (TIA) are more common (with an incidence of up to 13%) than intracranial hemorrhage (2.5%). Clinically, ischemic stroke is manifested by the appearance of focal neurologic deficits, although sometimes a stroke may be silent or manifests itself by the appearance of encephalopathy, reflecting a diffuse brain disorder. Ischemic stroke subtypes distribution in perioperative and postoperative period after OHT is very different from classical distribution, with different pathogenic mechanisms. Infact, ischemic stroke may be caused by less common and unusual mechanisms, linked to surgical procedures and to postoperative inflammation, peculiar to this group of patients. However, many strokes (40%) occur without a well-defined etiology (cryptogenic strokes). A silent atrial fibrillation (AF) may play a role in pathogenesis of these strokes and P wave dispersion may represent a predictor of AF. In OHT patients, P wave dispersion correlates with homocysteine plasma levels and hyperhomocysteinemia could play a role in the pathogenesis of these strokes with multiple mechanisms increasing the risk of AF. In conclusion, stroke after heart transplantation represents a complication with considerable impact not only on mortality but also on subsequent poor functional outcome.
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Affiliation(s)
- Maurizio Acampa
- Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, viale Bracci, Siena, Italy
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci, Siena, Italy
| | - Francesca Guideri
- Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, viale Bracci, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, viale Bracci, Siena, Italy
| | - Giuseppe Martini
- Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, viale Bracci, Siena, Italy
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63
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Wdowczyk J, Makowiec D, Dorniak K, Gruchała M. Visualization of Heart Rate Variability of Long-Term Heart Transplant Patient by Transition Networks: A Case Report. Front Physiol 2016; 7:79. [PMID: 27014081 PMCID: PMC4780201 DOI: 10.3389/fphys.2016.00079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 02/17/2016] [Indexed: 12/17/2022] Open
Abstract
We present a heart transplant patient at his 17th year of uncomplicated follow-up. Within a frame of routine check out several tests were performed. With such a long and uneventful follow-up some degree of graft reinnervation could be anticipated. However, the patient's electrocardiogram and exercise parameters seemed largely inconclusive in this regard. The exercise heart rate dynamics were suggestive of only mild, if any parasympathetic reinnervation of the graft with persisting sympathetic activation. On the other hand, traditional heart rate variability (HRV) indices were inadequately high, due to erratic rhythm resulting from interference of the persisting recipient sinus node or non-conducted atrial parasystole. New tools, originated from network representation of time series, by visualization short-term dynamical patterns, provided a method to discern HRV increase due to reinnervation from other reasons.
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Affiliation(s)
- Joanna Wdowczyk
- 1st Chair and Clinic of Cardiology, Medical University of Gdańsk Gdańsk, Poland
| | - Danuta Makowiec
- Institute of Theoretical Physics and Astrophysics, University of Gdańsk Gdańsk, Poland
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, 2nd Chair of Cardiology, Medical University of Gdańsk Gdańsk, Poland
| | - Marcin Gruchała
- 1st Chair and Clinic of Cardiology, Medical University of Gdańsk Gdańsk, Poland
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Moore-Gibbs A, Bither C. Cardiac Transplantation: Considerations for the Intensive Care Unit Nurse. Crit Care Nurs Clin North Am 2015; 27:565-75. [PMID: 26567499 DOI: 10.1016/j.cnc.2015.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Heart transplantation is a recommended and curative treatment option for patients with advanced heart failure symptoms despite receiving optimal medical and device therapy. The availability of donor organs limits the number of patients able to receive a heart transplant. The overall outcome of patients able to receive a heart transplant is determined by the successful delivery of essential nursing care. Understanding the specific interventions and therapies unique to this patient population is critical to their care. This article reviews considerations for the intensive care unit clinician in the management of heart transplant patients in this setting.
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Affiliation(s)
- Ashley Moore-Gibbs
- Advanced Heart Failure Program, Medstar Washington Hospital Center, 110 Irving Street, Adv HF Program, Washington, DC 20010, USA.
| | - Cindy Bither
- Advanced Heart Failure Program, Medstar Washington Hospital Center, 110 Irving Street, Adv HF Program, Washington, DC 20010, USA
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65
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Pacemaker implantation in pediatric heart transplant recipients: Predictors, outcomes, and impact on survival. Heart Rhythm 2015; 12:1776-81. [DOI: 10.1016/j.hrthm.2015.04.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Indexed: 11/20/2022]
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66
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Reed RM, Netzer G, Hunsicker L, Mitchell BD, Rajagopal K, Scharf S, Eberlein M. Cardiac size and sex-matching in heart transplantation : size matters in matters of sex and the heart. JACC-HEART FAILURE 2015; 2:73-83. [PMID: 24611131 DOI: 10.1016/j.jchf.2013.09.005] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study evaluated whether worsened outcomes in sex mismatch are related to mismatch of organ size in heart transplantation. BACKGROUND Sizing for organ allocation in heart transplantation currently incorporates only body weight differences between the donor and recipient. Weight correlates poorly to cardiac size, and donor–recipient weight differences are not associated with differential survival. Heart size correlates with sex, and donor–recipient sex mismatch conveys worse-than-expected outcomes. METHODS We performed a retrospective cohort study of 31,634 donor–recipient adult heart transplant pairings from the United Network for Organ Sharing transplantation registry. We used predictive models to calculate the predicted total heart mass (pHM) for recipient and donor pairs. We assessed organ size mismatch by calculating the percent difference between the donor and recipient pHM as [(pHM(recipient) – pHM(donor))/(pHM(recipient))]*100. RESULTS The most-undersized pHM septile demonstrated higher mortality during the first year post-transplantation (hazard ratio [HR]: 1.27; p < 0.001), which remained robust in adjusted models (HR: 1.25; p = 0.03). Survival did not vary across septiles of weight differences. On univariate analysis, sex mismatch was associated with higher mortality in male patients, but not in female patients. Controlling for differences in pHM reversed these associations. Adjusted models demonstrated worse survival associated with sex mismatch in female patients (1-year HR: 1.28; p = 0.02) but no difference in male patients (1-year HR, 1.00; p = 1.0). CONCLUSIONS Differences in donor–recipient pHM modulated the survival associated with donor–recipient sex mismatch and identified donor heart undersizing as an otherwise occult and potentially preventable cause of mortality following orthotopic heart transplantation.
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67
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Hamon D, Taleski J, Vaseghi M, Shivkumar K, Boyle NG. Arrhythmias in the Heart Transplant Patient. Arrhythm Electrophysiol Rev 2014; 3:149-55. [PMID: 26835083 DOI: 10.15420/aer.2014.3.3.149] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/07/2014] [Indexed: 01/16/2023] Open
Abstract
Orthotopic 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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Affiliation(s)
- David Hamon
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, US
| | - Jane Taleski
- Department of Cardiac Electrophysiology, University Clinic of Cardiology, University of St. Cyril and Methodius, Skopje, Former Yugoslav Republic of Macedonia
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, US
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, US
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, US
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