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Frequency, Risk Factors, and Clinical Outcomes of Late-Onset Atrial Flutter in Patients after Heart Transplantation. J Cardiovasc Dev Dis 2022; 9:jcdd9100337. [PMID: 36286289 PMCID: PMC9604694 DOI: 10.3390/jcdd9100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
Aims: Atrial flutter (AFL) is a common late-onset complication after heart transplantation (HTX) and is associated with worse clinical outcomes. Methods: This study investigated the frequency, risk factors, and outcomes of late-onset post-transplant AFL. We analyzed 639 adult patients undergoing HTX at the Heidelberg Heart Center between 1989 and 2019. Patients were stratified by diagnosis and type of late-onset post-transplant AFL (>90 days after HTX). Results: A total of 55 patients (8.6%) were diagnosed with late-onset post-transplant AFL, 30 had typical AFL (54.5%) and 25 had atypical AFL (45.5%). Patients with AFL were younger at HTX (p = 0.028), received more biatrial anastomosis (p = 0.001), and presented with moderate or severe tricuspid regurgitation (56.4%). Typical AFL was associated with graft rejection (p = 0.016), whereas atypical AFL was associated with coronary artery disease (p = 0.028) and stent implantation (p = 0.042). Patients with atypical AFL showed a higher all-cause 1-year mortality (p = 0.010) along with a higher rate of graft failure after diagnosis of AFL (p = 0.023). Recurrence of AFL was high (83.6%). Patients with catheter ablation after AFL recurrence had a higher 1-year freedom from AFL (p = 0.003). Conclusions: Patients with late-onset post-transplant AFL were younger at HTX, received more biatrial anastomosis, and showed a higher rate of moderate or severe tricuspid regurgitation. Typical AFL was associated with graft rejection, whereas atypical AFL was associated with myocardial ischemia, graft failure, and mortality. Catheter ablation represents a viable option to avoid further episodes of late-onset AFL after HTX.
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Herweg B, Nellaiyappan M, Welter-Frost AM, Tran T, Mabry G, Weston K, Tobón C, Saiz J, Noujaim S, Weston MW. Immuno-Electrophysiological Mechanisms of Functional Electrical Connections Between Recipient and Donor Heart in Patients With Orthotopic Heart Transplantation Presenting With Atrial Arrhythmias. Circ Arrhythm Electrophysiol 2021; 14:e008751. [PMID: 33724864 DOI: 10.1161/circep.120.008751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Bengt Herweg
- Department of Cardiovascular Sciences (B.H., M.N., A.M.W.-F., T.T., G.M., K.W., S.N., M.W.W.), University of South Florida Morsani College of Medicine.,Tampa General Hospital, Florida (B.H., T.T., M.W.W.)
| | - Madhan Nellaiyappan
- Department of Cardiovascular Sciences (B.H., M.N., A.M.W.-F., T.T., G.M., K.W., S.N., M.W.W.), University of South Florida Morsani College of Medicine
| | - Allan M Welter-Frost
- Department of Cardiovascular Sciences (B.H., M.N., A.M.W.-F., T.T., G.M., K.W., S.N., M.W.W.), University of South Florida Morsani College of Medicine
| | - Thanh Tran
- Department of Cardiovascular Sciences (B.H., M.N., A.M.W.-F., T.T., G.M., K.W., S.N., M.W.W.), University of South Florida Morsani College of Medicine.,Tampa General Hospital, Florida (B.H., T.T., M.W.W.)
| | - George Mabry
- Department of Cardiovascular Sciences (B.H., M.N., A.M.W.-F., T.T., G.M., K.W., S.N., M.W.W.), University of South Florida Morsani College of Medicine
| | - Kathryn Weston
- Department of Cardiovascular Sciences (B.H., M.N., A.M.W.-F., T.T., G.M., K.W., S.N., M.W.W.), University of South Florida Morsani College of Medicine
| | - Catalina Tobón
- Nanostructured Materials and Bio-modeling (MATBIOM), Universidad de Medellín, Colombia (C.T.)
| | - Javier Saiz
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, Spain (J.S.)
| | - Sami Noujaim
- Department of Cardiovascular Sciences (B.H., M.N., A.M.W.-F., T.T., G.M., K.W., S.N., M.W.W.), University of South Florida Morsani College of Medicine.,Molecular Pharmacology and Physiology (S.N.), University of South Florida Morsani College of Medicine
| | - Mark W Weston
- Department of Cardiovascular Sciences (B.H., M.N., A.M.W.-F., T.T., G.M., K.W., S.N., M.W.W.), University of South Florida Morsani College of Medicine.,Tampa General Hospital, Florida (B.H., T.T., M.W.W.)
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3
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Joglar JA, Wan EY, Chung MK, Gutierrez A, Slaughter MS, Bateson BP, Loguidice M, Drazner M, Kistler PM, Saour B, Poole JE, Murtaza G, Turagam MK, Vader J, Lakkireddy D, Birati EY, Dhingra R, Gopinathannair R. Management of Arrhythmias After Heart Transplant: Current State and Considerations for Future Research. Circ Arrhythm Electrophysiol 2021; 14:e007954. [PMID: 33685207 DOI: 10.1161/circep.120.007954] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Orthotropic heart transplantation remains the most effective therapy for patients with end-stage heart failure, with a median survival of ≈13 years. Yet, a number of complications are observed after orthotropic heart transplantation, including atrial and ventricular arrhythmias. Several factors contribute to arrhythmias, such as autonomic denervation, effect of the surgical technique, acute and chronic rejection, and transplant vasculopathy among others. To minimize risk of future arrhythmias, the bicaval technique and minimizing ischemic time are current surgical standards. Sinus node dysfunction is the most common indication for early (within 30 days) pacemaker implantation, whereas atrioventricular block incidence increases as time from transplant increases. Atrial fibrillation can occur in the first few weeks following transplantation but is uncommon in the long term unless secondary to a precipitant such as acute rejection. The most common atrial arrhythmias are atrial flutters, which are mainly typical, but atypical circuits can be observed such as those that involve the remnant donor atrium in regions immediately adjacent to the atrioatrial anastomosis suture line. Choosing the appropriate pharmacological therapy requires careful consideration due to the potential interaction with immunosuppressive agents. Despite historical concerns, adenosine is effective and safe at reduced doses if administered under cardiac monitoring. Catheter ablation has emerged as an effective treatment strategy for symptomatic supraventricular tachycardias, including ablation of atypical flutter circuits. Cardiac allograft vasculopathy is an important risk factor for sudden cardiac death, yet the role of prophylactic implantable cardioverter-defibrillator implant for sudden death prevention is unclear. Current indications for implantable cardioverter-defibrillator implantation are as in the nontransplant population. A number of questions for future research are posed.
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Affiliation(s)
- Jose A Joglar
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.J., M.L., M.D.)
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY (E.Y.W.)
| | - Mina K Chung
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (M.K.C.).,Department of Cardiovascular Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (M.K.T.)
| | | | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, KY (M.S.S., B.P.B.)
| | - Brian P Bateson
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, KY (M.S.S., B.P.B.)
| | - Michael Loguidice
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.J., M.L., M.D.)
| | - Mark Drazner
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.J., M.L., M.D.)
| | - Peter M Kistler
- Heart Centre, The Alfred Hospital, Melbourne, Australia (P.M.K.)
| | - Basil Saour
- Department of Internal Medicine, University of Washington, Seattle (B.S., J.E.P.)
| | - Jeanne E Poole
- Department of Internal Medicine, University of Washington, Seattle (B.S., J.E.P.)
| | - Ghulam Murtaza
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS (G.M., D.L., R.G.)
| | | | - Justin Vader
- Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (J.V.)
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS (G.M., D.L., R.G.)
| | - Edo Y Birati
- Advanced Heart Failure/Transplantation Program, Division of Cardiovascular Medicine, Department of Internal Medicine, Perelman School of Medicine, Philadelphia, PA (E.Y.B.)
| | - Ravi Dhingra
- Advanced Heart Disease and Transplant, Division of Cardiology, University of Wisconsin, Madison (R.D.)
| | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS (G.M., D.L., R.G.)
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Renedo MF, González JL, Giunta GA, Giordanino EF, Ameri AS, Mysuta MA, Ramirez DA, Favaloro LE, Favaloro RR, Absi DO, Galizio NO, Bertolotti AM. Radiofrequency ablation of supraventricular arrhythmias after orthotopic heart transplantation: Long-term follow-up of a single-center experience. Clin Transplant 2020; 35:e14165. [PMID: 33226674 DOI: 10.1111/ctr.14165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- María F Renedo
- Heart Failure, Mechanical Circulatory Support and Heart Transplant Unit, Cardiothoracic Organ Transplantation Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - José L González
- Electrophysiology Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Gustavo A Giunta
- Heart Failure, Mechanical Circulatory Support and Heart Transplant Unit, Cardiothoracic Organ Transplantation Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Elián F Giordanino
- Heart Failure, Mechanical Circulatory Support and Heart Transplant Unit, Cardiothoracic Organ Transplantation Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Aldana S Ameri
- Heart Failure, Mechanical Circulatory Support and Heart Transplant Unit, Cardiothoracic Organ Transplantation Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Mauricio A Mysuta
- Electrophysiology Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Debora A Ramirez
- Electrophysiology Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Liliana E Favaloro
- Heart Failure, Mechanical Circulatory Support and Heart Transplant Unit, Cardiothoracic Organ Transplantation Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Roberto R Favaloro
- Heart Failure, Mechanical Circulatory Support and Heart Transplant Unit, Cardiothoracic Organ Transplantation Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Daniel O Absi
- Heart Failure, Mechanical Circulatory Support and Heart Transplant Unit, Cardiothoracic Organ Transplantation Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Néstor O Galizio
- Electrophysiology Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Alejandro M Bertolotti
- Heart Failure, Mechanical Circulatory Support and Heart Transplant Unit, Cardiothoracic Organ Transplantation Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
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Von Wald L, Roukoz H. Atrial tachycardia involving both recipient and donor right atria through two atrioatrial connections in a heart transplant recipient. HeartRhythm Case Rep 2020; 6:867-870. [PMID: 33204624 PMCID: PMC7653470 DOI: 10.1016/j.hrcr.2020.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Henri Roukoz
- Address reprint requests and correspondence: Dr Henri Roukoz, Assistant Professor of Medicine, Cardiovascular Division, Department of Medicine, University of Minnesota, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455.
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Masarone D, Vastarella R, Melillo E, Petraio A, Pacileo G. Beta-blocker therapy in heart transplant recipients: A review. Clin Transplant 2020; 34:e14081. [PMID: 32941656 DOI: 10.1111/ctr.14081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Abstract
Beta-blockers are essential drugs for the treatment of many cardiovascular diseases, such as heart failure, acute and chronic ischemic heart disease, tachyarrhythmias, and hypertension. However, these drugs have not been used in cardiac transplant patients for many years owing to the fear that they could reduce cardiac output and functional capacity. In recent years, however, some evidence has shown that even in cardiac transplanted patients, β-blockers are useful and effective in the treatment of sinus tachycardia, supraventricular and ventricular tachyarrhythmias, left ventricular systolic dysfunction, and arterial hypertension. Furthermore, some data have shown that the use of β-blockers is associated with reduced mortality in heart transplant recipients. In this review, we summarize this evidence with particular emphasis on the practical aspects of the use of β-blockers in post-transplantation patients to promote the use of this important class of drugs in clinical practice.
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Affiliation(s)
- Daniele Masarone
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Rossella Vastarella
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Enrico Melillo
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Heart Transplant, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
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7
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Shi R, Chen Z, Mantziari L, Wong T. Multiple atrial tachycardias after orthotopic heart transplantation: A case report and literature review. HeartRhythm Case Rep 2018; 4:538-541. [PMID: 30479955 PMCID: PMC6241167 DOI: 10.1016/j.hrcr.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Kawai S, Mukai Y, Chishaki A, Tsutsui H. Dissociated electrical activities in the left atrial posterior wall seen in a patient with focal atrial tachycardia after heart transplantation. Eur Heart J Case Rep 2017; 1:ytx007. [PMID: 31020066 PMCID: PMC6176982 DOI: 10.1093/ehjcr/ytx007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/19/2017] [Accepted: 10/06/2017] [Indexed: 06/09/2023]
Affiliation(s)
- Shunsuke Kawai
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
| | - Yasushi Mukai
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
| | - Akiko Chishaki
- Department of Health Sciences, Kyushu University Hospital, Higashiku, Fukuoka 812-8582, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
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9
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Badin A, Tyler J, Kalbfleisch SJ. Atrial fibrillation originating from recipient left atrium after an orthotopic heart transplantation. HeartRhythm Case Rep 2017; 3:604-607. [PMID: 29296586 PMCID: PMC5741815 DOI: 10.1016/j.hrcr.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Auroa Badin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jaret Tyler
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio
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10
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Zacà V, Gaddi R, Baiocchi C, Mercurio M, Favilli R. Postpartum donor heart atrial tachycardia very late after orthotopic cardiac transplantation. J Cardiovasc Med (Hagerstown) 2017; 18:793-795. [PMID: 28857926 DOI: 10.2459/jcm.0b013e328362c259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Valerio Zacà
- aDivision of Cardiology, Cardiovascular and Thoracic Department, Santa Maria alle Scotte Hospital, Siena bBiosense Webster, Italy and Johnson & Johnson Medical, Milan, Italy
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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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12
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Bulut M, Evlice M, Celik M, Eren H, Savluk ÖF, Acar RD, Tabakci M, Emiroglu MY, Otcu (Nurse) O, Kargin R, Balkanay M, Akcakoyun M. Atrial electromechanical delay in patients undergoing heart transplantation. J Arrhythm 2017; 33:122-126. [PMID: 28416978 PMCID: PMC5388059 DOI: 10.1016/j.joa.2016.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/24/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022] Open
Abstract
Background We aimed to assess atrial electromechanical delay (AEMD) in patients who had undergone heart transplantation. Methods A total of 32 patients who underwent biatrial anastomosis heart transplantation (24 men, 8 women; mean age: 42±11 years) and 30 healthy volunteers (20 men, 10 women; mean age: 36±13 years) were included in the study. Atrial electromechanical coupling (PA), intra-AEMD, and inter-AEMD were measured. Results PA lateral (68±7 vs. 51±11 ms, p<0.01), PA septal (50±5 vs. 42±8 ms, p< 0.01) and PA tricuspid (39±6 vs. 36±9 ms, p<0.01), inter-AEMD (PA lateral–PA tricuspid) (27±7 vs. 10±4 ms, p<0.01), left intra-AEMD (PA lateral–PA septal) (18±7 vs. 10±4 ms, p<0.01), right intra-AEMD (PA septal–PA tricuspid) (13±5 vs. 5±3 ms, p<0.01) values were higher in patients who underwent heart transplantation than in a control population. Conclusion Inter-AEMD and intra-AEMD were prolonged in patients who underwent heart transplantation as compared to a control population. This may explain the increased atrial fibrillation and other atrial arrhythmia incidences associated with the biatrial anastomosis heart transplantation technique and may contribute to the treatment of atrial fibrillation in this special patient group.
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Affiliation(s)
- Mustafa Bulut
- Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Mert Evlice
- Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Celik
- Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Hayati Eren
- Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Ömer F. Savluk
- Department of Anesthesia, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Rezzan D. Acar
- Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Tabakci
- Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Y. Emiroglu
- Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Otcu (Nurse)
- Department of Cardiovascular Surgery, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Kargin
- Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Balkanay
- Department of Cardiovascular Surgery, Katip Celebi University and Ataturk Training and Research Hospital, Izmir, Turkey
| | - Mustafa Akcakoyun
- Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
- Correspondence to: Department of Cardiology, Kartal Kosuyolu High Speciality Training and Research Hospital, 34846, Kartal, Istanbul, Turkey. Fax: +90 216 4596321.
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13
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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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14
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Jin Q, Pehrson S, Jacobsen PK, Chen X. Mapping strategy for multiple atrial tachyarrhythmias in a transplant heart. BMC Cardiovasc Disord 2015; 15:38. [PMID: 25964112 PMCID: PMC4443606 DOI: 10.1186/s12872-015-0031-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Different atrial arrhythmias can coexist in the recipient and donor atria after heart transplantation. Case presentation We report an unusual case of a patient with three different types of atrial arrhythmia after heart transplantation: an atrial fibrillation in the recipient atria, and a cavotricuspid isthmus dependent atrial flutter and a focal atrial tachycardia in the donor atria. 3D electroanatomical mapping and ablation were guided by remote magnetic navigation (RMN). Atrial fibrillation continued in the recipient atria even after the donor heart was converted to sinus rhythm by ablation. Conclusions It is critical to understand the surgical anatomy of a bi-atrial anastomosis and its relevant electrical activation pattern before ablation. Appropriate electroanatomical mapping strategy with RMN can facilitate the successful ablation of post-transplant atrial arrhythmias.
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Affiliation(s)
- Qi Jin
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. .,Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Steen Pehrson
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Peter Karl Jacobsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Xu Chen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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15
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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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16
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LAKSMAN ZACHARYW, SKANES ALLANC, KLEIN GEORGEJ, MANLUCU JAIMIE. Dual Atrial Tachycardia in a Transplant Heart: When is “In” Really “Out”? J Cardiovasc Electrophysiol 2013; 24:1428-31. [DOI: 10.1111/jce.12244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 11/29/2022]
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