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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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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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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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Mouhoub Y, Laredo M, Varnous S, Leprince P, Waintraub X, Gandjbakhch E, Hébert JL, Frank R, Maupain C, Pavie A, Hidden-Lucet F, Duthoit G. Catheter ablation of organized atrial arrhythmias in orthotopic heart transplantation. J Heart Lung Transplant 2017; 37:S1053-2498(17)31924-1. [PMID: 28784326 DOI: 10.1016/j.healun.2017.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Organized atrial arrhythmias (OAAs) are common after orthotopic heart transplantation (OHT). Some controversies remain about their clinical presentation, relationship with atrial anastomosis and electrophysiologic features. The objectives of this retrospective study were to determine the mechanisms of OAAs after OHT and describe the outcomes of radiofrequency catheter ablation (RFCA). METHODS Thirty consecutive transplanted patients (mean age 48 ± 17 years, 86.6% male) underwent 3-dimensional electroanatomic mapping and RFCA of their OAA from 2004 to 2012 at our center. RESULTS Twenty-two patients had biatrial anastomosis and 8 had bicaval anastomosis. Macro-reentry was the arrhythmia mechanism for 96% of patients. The electrophysiologic diagnoses were: cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) in 93% of patients (n = 28); perimitral AFL in 3% (n = 1); and focal atrial tachycardia (FAT) in 3% (n = 1). In 5 patients with biatrial anastomosis, a right FAT was inducible. Primary RFCA success was obtained in 93% of patients. Mean follow-up time was 39 ± 26.8 months. Electrical repermeation between recipient and donor atria, present in 20% of patients (n = 6), did not account for any of the OAAs observed. Survival without OAA relapse at 12, 24 and 60 months was 93%, 89% and 79%, respectively. CONCLUSIONS CTI-dependent AFL accounted for most instances of OAA after OHT, regardless of anastomosis type. Time from transplantation to OAA was shorter with bicaval than with biatrial anastomosis. RFCA was safe and provided good long-term results.
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Affiliation(s)
- Yamina Mouhoub
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Mikael Laredo
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Shaida Varnous
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pascal Leprince
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Xavier Waintraub
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Estelle Gandjbakhch
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Louis Hébert
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Robert Frank
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Carole Maupain
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain Pavie
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Guillaume Duthoit
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
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Lehmann GC, Van Hare GF, Avari Silva JN. Atrial tachycardia in an electrically dissociated native right atrium after heart transplantation. HeartRhythm Case Rep 2016; 2:356-359. [PMID: 28491709 PMCID: PMC5419896 DOI: 10.1016/j.hrcr.2016.04.004] [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: 11/25/2022] Open
Affiliation(s)
- Gloria C Lehmann
- Division of Pediatric Cardiology, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - George F Van Hare
- Division of Pediatric Cardiology, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - Jennifer N Avari Silva
- Division of Pediatric Cardiology, Washington University in St. Louis School of Medicine, St Louis, Missouri
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Abstract
Atrial tachycardia and atrial flutter are common tachyarrhythmias in the heart failure population. They commonly lead to, exacerbate, and increase the morbidity and mortality associated with heart failure and, thereby, warrant urgent and early definitive therapy in the form of catheter ablation. Catheter ablation requires careful patient stabilization and extensive preprocedural planning, particularly with regards to anesthesia, strategy, catheter choice, mapping system, and fluid balance, to increase efficacy and limit adverse effects. Heart failure may limit the success of catheter ablation with higher reported recurrence rates, and in selected patients, a hybrid epicardial-endocardial ablation can be considered.
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Affiliation(s)
- Ayotunde Bamimore
- Division of Cardiology, University of North Carolina, Chapel Hill, 160 Dental Circle, Burnett-Womack Building, CB #7075, Chapel Hill, NC 27599, USA
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[Heart failure secondary to atrial tachycardia in the early phase of heart transplantation. Usefulness of the electrophysiological study]. Med Intensiva 2011; 36:377-9. [PMID: 22037020 DOI: 10.1016/j.medin.2011.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 08/31/2011] [Accepted: 09/05/2011] [Indexed: 11/22/2022]
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Dahu MI, Hutchinson MD. What is the mechanism of the atrial arrhythmia in a patient after orthotopic heart transplantation? J Cardiovasc Electrophysiol 2011; 23:225-7. [PMID: 21668560 DOI: 10.1111/j.1540-8167.2011.02106.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Musa I Dahu
- Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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D'Alto M, Lord S, Bourke J, Santarpia G, Sarubbi B, Russo MG, Calabrò R. Orthotopic heart transplantation: two parts of the heart with two different arrhythmias. J Cardiovasc Med (Hagerstown) 2011; 12:193-6. [DOI: 10.2459/jcm.0b013e328336ecaf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Atrial flutter after heart transplantation: mechanism and catheter ablation. Transplant Proc 2010; 42:2697-701. [PMID: 20832572 DOI: 10.1016/j.transproceed.2010.04.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 04/01/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Atrial flutter is a frequent arrhythmia after heart transplantation, but little is known about its mechanism and treatment. We report the results of an electrophysiologic study in patients with atrial flutter after orthotopic heart transplantation, describing its mechanism and demonstrating the acute and long-term efficacy of catheter ablation for treating this arrhythmia. METHODS We included 14 patients with symptomatic atrial flutter after orthotopic heart transplantation. All of them underwent an electrophysiologic study to determine the mechanism of the arrhythmia and catheter ablation when possible. RESULTS Counterclockwise right atrial circuit around the tricuspid annulus involving the cavotricuspid isthmus was demonstrated in 13 patients (86%). Catheter ablation of the isthmus was performed with good acute results in all but 1. During a mean follow-up of 24 ± 17 months, recurrent atrial flutter was documented in 3 patients and atrial fibrillation in 2. In another patient, we demonstrated a left atrial origin. CONCLUSIONS The most common mechanism of atrial flutter in heart transplant recipients is a counterclockwise circuit around the tricuspid annulus involving the cavotricuspid isthmus. Catheter ablation of the isthmus between tricuspid annulus and posterior atrial suture line represents an effective treatment in these patients. This condition may be avoided by changing the surgical technique to a bicaval anastomosis.
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HIV/AIDS research in China: arising up from skyline. Chin Med J (Engl) 2006. [DOI: 10.1097/00029330-200612010-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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