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Tednes P, Marquardt S, Kuhrau S, Heagler K, Rech M. Keeping It "Current": A Review of Treatment Options for the Management of Supraventricular Tachycardia. Ann Pharmacother 2024; 58:715-727. [PMID: 37743672 DOI: 10.1177/10600280231199136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE To review treatment options and updates that exist for the management of paroxysmal supraventricular tachycardia (PSVT). DATA SOURCES A literature search of PubMed was performed including articles from 1974 to June 2023 using the terms: arrhythmias, adenosine, verapamil, diltiazem, esmolol, propranolol, metoprolol, beta-blockers, amiodarone, PSVT, synchronized cardioversion, methylxanthines, dipyridamole, pediatrics, heart transplant, and pregnancy. Primary literature and guidelines were reviewed. STUDY SELECTION AND DATA EXTRACTION Studies were considered if they were available in English and conducted in humans. DATA SYNTHESIS PSVT is a subset of supraventricular tachycardia (SVT) that presents as a rapid, regular tachycardia with an abrupt onset and termination. Due to frequent emergency department (ED) visits annually with symptoms of PSVT, appropriate and efficient management of these patients is vital. This review provides an overview of the pathophysiology of PSVT, while also describing the literature behind nonpharmacologic and pharmacologic management of PSVT. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review describes new literature regarding the improved success of the modified Valsalva maneuver as a nonpharmacologic therapy in PSVT. In addition, it describes a new technique in administration of adenosine that has improved outcomes, defines dose adjustments needed for drug interactions with adenosine, compares the utilization of nondihydropyridine calcium channel blockers with adenosine, and provides management recommendations for patients in special populations. CONCLUSIONS With high annual rates of ED visits for SVT, providers should be aware of the data behind management and modifications of therapy based on patient-specific factors (ie, patient preference, pharmacokinetics/pharmacodynamics, drug interactions, and special populations).
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Affiliation(s)
- Patrick Tednes
- Department of Pharmacy, Ascension Resurrection Medical Center, Chicago, IL, USA
| | - Samantha Marquardt
- Department of Pharmacy, Ascension Resurrection Medical Center, Chicago, IL, USA
| | - Shannon Kuhrau
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Kristin Heagler
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Megan Rech
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Emergency Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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2
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Izekor B, Perez C, Banchs J, Olsovsky G. Posttransplant atrial fibrillation: Evidence of early posttransplant recipient-to-donor atrioatrial connections. J Cardiovasc Electrophysiol 2024; 35:511-515. [PMID: 38225537 DOI: 10.1111/jce.16180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/28/2023] [Accepted: 12/24/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Atrial fibrillation and atrial flutter originating from the donor s heart is a commonly reported complication post heart transplant. Atrial tachyarrhythmia originating from the recipient s heart, propagated through recipient-to-donor connections, is rare with only few cases reported in the literature; most reported cases from our review occur years post-transplant. CASE A 47-year-old male presented with atrial tachycardia 6 months post heart transplant. Electrophysiologic study demonstrated atrial fibrillation originating from native heart and propagated through atrio-atrial connections to the donor heart. This arrhythmia was successfully terminated with radiofrequency ablation. CONCLUSION Atrio-atrial connection between recipient and donor can form as early as a few months post heart transplant. Radiofrequency ablation appears to be an effective treatment for atrial fibrillation propagated through donor-to-recipient connections.
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Affiliation(s)
- Bright Izekor
- Department of Cardiology, Baylor Scott & White Medical Center-Temple, Temple, Texas, USA
| | - Christopher Perez
- Department of Cardiology, Baylor Scott & White Medical Center-Temple, Temple, Texas, USA
| | - Javier Banchs
- Department of Cardiology, Baylor Scott & White Medical Center-Temple, Temple, Texas, USA
| | - Gregory Olsovsky
- Department of Cardiology, Baylor Scott & White Medical Center-Temple, Temple, Texas, USA
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3
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Martini L, Mandoli GE, Pastore MC, Pagliaro A, Bernazzali S, Maccherini M, Henein M, Cameli M. Heart transplantation and biomarkers: a review about their usefulness in clinical practice. Front Cardiovasc Med 2024; 11:1336011. [PMID: 38327491 PMCID: PMC10847311 DOI: 10.3389/fcvm.2024.1336011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Advanced heart failure (AdvHF) can only be treated definitively by heart transplantation (HTx), yet problems such right ventricle dysfunction (RVD), rejection, cardiac allograft vasculopathy (CAV), and primary graft dysfunction (PGD) are linked to a poor prognosis. As a result, numerous biomarkers have been investigated in an effort to identify and prevent certain diseases sooner. We looked at both established biomarkers, such as NT-proBNP, hs-troponins, and pro-inflammatory cytokines, and newer ones, such as extracellular vesicles (EVs), donor specific antibodies (DSA), gene expression profile (GEP), donor-derived cell free DNA (dd-cfDNA), microRNA (miRNA), and soluble suppression of tumorigenicity 2 (sST2). These biomarkers are typically linked to complications from HTX. We also highlight the relationships between each biomarker and one or more problems, as well as their applicability in routine clinical practice.
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Affiliation(s)
- L. Martini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - G. E. Mandoli
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - M. C. Pastore
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - A. Pagliaro
- Cardio-Thoracic-Vascular Department, Siena University Hospital, Siena, Italy
| | - S. Bernazzali
- Cardio-Thoracic-Vascular Department, Siena University Hospital, Siena, Italy
| | - M. Maccherini
- Cardio-Thoracic-Vascular Department, Siena University Hospital, Siena, Italy
| | - M. Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - M. Cameli
- Department of Medical Biotechnology, University of Siena, Siena, Italy
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4
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Roth HR, Reinert JP. Methylxanthine Derivatives in the Treatment of Sinus Node Dysfunction: A Systematic Review. Cardiol Rev 2023:00045415-990000000-00159. [PMID: 37909739 DOI: 10.1097/crd.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
While the chronotropic effects of theophylline and aminophylline are well-known, their clinical application in the treatment of sinus node dysfunction has not been established in a review. The purpose of this systematic review is to evaluate the efficacy and safety of methylxanthines in the treatment of bradyarrhythmias associated with sinus node dysfunction. A systematic review was conducted in accordance with PRISMA guidelines on Embase, PubMed, MEDLINE, Cochrane Central, Web of Science, SciELO, Korean Citation Index, Global Index Medicus, and CINAHL through June 2023. A total of 607 studies were identified through the literature search. After applying the inclusion and exclusion criteria, 14 studies were included in this review. The causes of bradyarrhythmias involving the sinoatrial node included acute cervical spinal cord injury, coronavirus disease of 2019, carotid sinus syncope, chronotropic incompetence, heart transplant, and chronic sinus node dysfunction. Theophylline and aminophylline were shown to be effective for increasing heart rate and reducing the reoccurrence of bradyarrhythmias. The data on symptom resolution was conflicting. While many case studies reported a resolution of symptoms, a randomized controlled trial reported no significant difference in symptom scores between the control, theophylline, and pacemaker groups in the treatment of sick sinus syndrome. The incidence of adverse effects was low across all study designs. The data suggests methylxanthines may be useful as an alternative or bridge to nonpharmacologic pacing; however, dosing has yet to be established for various indications. Overall, methylxanthines proved safe and effective as a pharmacologic therapy for bradyarrhythmic manifestations of sinus node dysfunction.
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Affiliation(s)
- Hunter R Roth
- From the Department of Pharmacy Practice, The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH
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5
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Med Sidi El Moctar E, El Hadj Sidi C, Abdulrazzak M, Ahmed Kamal M, Mohamed Ahmed MF, Boye K. Giant right atrial myxoma presented with symptoms of Budd-Chiari syndrome: a case report. Ann Med Surg (Lond) 2023; 85:4593-4596. [PMID: 37663686 PMCID: PMC10473319 DOI: 10.1097/ms9.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/15/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction and importance Right atrial myxoma is rarely associated with Budd-Chiari syndrome (BCS). In this paper, we present a case of a young patient with a giant right atrial myxoma complicated by the development of BCS. Case presentation A 26-year-old female presented to the emergency room with persistent abdominal pain, ascites, lower limb edema, and an acute episode of dyspnea. Abdominal computed tomography revealed a lesion in the right cardiac cavity that resembled an intracardiac thrombus. Transthoracic echocardiography showed a large heterogeneous mass in the right atrium protruding into the right ventricle and a large thrombus interfering with inferior vena cava flow. The patient underwent cardiac surgery to remove the atrial mass, and histopathologic examinations confirmed the diagnosis of atrial myxoma. Clinical discussion The right atrial myxoma is relatively rare, especially the giant ones. Rarely have intracardiac tumors such as giant right atrial myxoma been identified as a risk factor for the onset of BCS. Conclusion In the differential diagnosis of BCS, right atrial tumors, including myxomas, should be considered, especially when other explanations are absent.
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Affiliation(s)
| | | | | | | | | | - Khaled Boye
- Center National de Cardiology, Nouakchott, Mauritania
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6
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Strey G. Second look diagnosis: dual sinus nodes rhythm in heart transplant patient. Med J Aust 2023; 219:152. [PMID: 37474132 DOI: 10.5694/mja2.52045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/16/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Gabriela Strey
- Wide Bay Hospital and Health Service South, Hervey Bay Hospital, Hervey Bay, QLD
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7
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Do DH, Bailey KL, Beyer R, Neubuerger S, Bradfield J, Shivkumar K, Nsair A, Boyle NG. Outcomes in orthotopic heart transplantation following pacemaker implantation. Pacing Clin Electrophysiol 2023; 46:583-591. [PMID: 37221975 PMCID: PMC10524466 DOI: 10.1111/pace.14716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Bradyarrhythmias including sinus node dysfunction (SND) and atrioventricular block (AVB) can necessitate pacemaker (PPM) implantation in orthotopic heart transplant (OHT) recipients. Prior studies have shown conflicting findings regarding the effect of PPM implantation on survival. We evaluated the effect of PPM indication on long-term re-transplant-free survival in OHT patients. METHODS We conducted a retrospective cohort study of OHT patients at UCLA Medical Center from 1985 to 2018. Indication for PPM (SND, AVB) was identified. Cox proportional hazards model with pacemaker implantation as a time-varying covariate was used to evaluate its effect on the primary endpoint of retransplant or death. We included 1609 OHTs in 1511 adult patients with median follow-up of 12 years. RESULTS At transplant, patients were aged 53 ± 13 years and 1125 (74.5%) were male. Pacemakers were implanted in 109 (7.2%) patients; 65 for SND (4.3%) and 43 for AVB (2.8%). Repeat OHT was performed in 103 (6.4%) cases and 798 (52.8%) patients died during the follow-up period. The risk of the primary endpoint was significantly higher in patients requiring PPM for AVB (HR 3.0, 95% CI 2.1-4.2, p < .01) after controlling for age at OHT, gender, hypertension, diabetes, renal disease, history of repeat OHT, acute rejection, transplant coronary vasculopathy, and atrial fibrillation, but not PPM for SND (HR 1.0, 95% CI 0.70-1.4, p = 1.0). CONCLUSIONS Patients who required PPM for AVB, but not SND, were at significantly higher risk of death or retransplant compared to patients who did not require PPM.
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Affiliation(s)
- Duc H Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Katherine L Bailey
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Ryan Beyer
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Samuel Neubuerger
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Jason Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Ali Nsair
- UCLA Heart Transplant Program, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
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8
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Adedinsewo D, Hardway HD, Morales-Lara AC, Wieczorek MA, Johnson PW, Douglass EJ, Dangott BJ, Nakhleh RE, Narula T, Patel PC, Goswami RM, Lyle MA, Heckman AJ, Leoni-Moreno JC, Steidley DE, Arsanjani R, Hardaway B, Abbas M, Behfar A, Attia ZI, Lopez-Jimenez F, Noseworthy PA, Friedman P, Carter RE, Yamani M. Non-invasive detection of cardiac allograft rejection among heart transplant recipients using an electrocardiogram based deep learning model. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:71-80. [PMID: 36974261 PMCID: PMC10039431 DOI: 10.1093/ehjdh/ztad001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/08/2022] [Indexed: 01/15/2023]
Abstract
Aims Current non-invasive screening methods for cardiac allograft rejection have shown limited discrimination and are yet to be broadly integrated into heart transplant care. Given electrocardiogram (ECG) changes have been reported with severe cardiac allograft rejection, this study aimed to develop a deep-learning model, a form of artificial intelligence, to detect allograft rejection using the 12-lead ECG (AI-ECG). Methods and results Heart transplant recipients were identified across three Mayo Clinic sites between 1998 and 2021. Twelve-lead digital ECG data and endomyocardial biopsy results were extracted from medical records. Allograft rejection was defined as moderate or severe acute cellular rejection (ACR) based on International Society for Heart and Lung Transplantation guidelines. The extracted data (7590 unique ECG-biopsy pairs, belonging to 1427 patients) was partitioned into training (80%), validation (10%), and test sets (10%) such that each patient was included in only one partition. Model performance metrics were based on the test set (n = 140 patients; 758 ECG-biopsy pairs). The AI-ECG detected ACR with an area under the receiver operating curve (AUC) of 0.84 [95% confidence interval (CI): 0.78-0.90] and 95% (19/20; 95% CI: 75-100%) sensitivity. A prospective proof-of-concept screening study (n = 56; 97 ECG-biopsy pairs) showed the AI-ECG detected ACR with AUC = 0.78 (95% CI: 0.61-0.96) and 100% (2/2; 95% CI: 16-100%) sensitivity. Conclusion An AI-ECG model is effective for detection of moderate-to-severe ACR in heart transplant recipients. Our findings could improve transplant care by providing a rapid, non-invasive, and potentially remote screening option for cardiac allograft function.
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Affiliation(s)
- Demilade Adedinsewo
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Heather D Hardway
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Andrea Carolina Morales-Lara
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Mikolaj A Wieczorek
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Erika J Douglass
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Bryan J Dangott
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Raouf E Nakhleh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Tathagat Narula
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Parag C Patel
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Rohan M Goswami
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Melissa A Lyle
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Alexander J Heckman
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | | | - D Eric Steidley
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Brian Hardaway
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Mohsin Abbas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Paul Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Mohamad Yamani
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
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9
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Raboud M, Humm AM, Vivekanantham H, Suter P. Transient central hypoxemia due to intermittent high-degree atrioventricular block in a heart-transplanted patient diagnosed during routine electroencephalography: a case report. J Med Case Rep 2023; 17:3. [PMID: 36604735 PMCID: PMC9817384 DOI: 10.1186/s13256-022-03574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/18/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Bradycardia frequently occurs in heart-transplanted patients, mainly as a temporally restricted manifestation early after transplantation and often without symptoms. A high-degree atrioventricular block is mostly symptomatic through cerebral hypoxia induced through cerebral hypoperfusion. Only a few published cases show this specific electroencephalography result in this context. The purpose of this case is to bring attention to atypical manifestations of typical cardiac complications after heart transplantation and the importance of perseverance in the diagnostic. CASE PRESENTATION A Central European man in his 50s with history of heart transplantation 31 years previously was admitted to the internal medicine ward for short-lived recurrent episodes of generalized weakness with multiple falls but without loss of consciousness. During routine electroencephalography, the patient perceived this recurrent sensation. This episode coincided with a transient third-degree atrioventricular block followed 8-10 seconds later by a generalized slowing of the electroencephalography, reflecting cerebral hypoxia due to cerebral hypoperfusion. Holter monitoring confirmed the diagnosis. A pacemaker was implanted, consequently resolving the episodes. CONCLUSION This case report illustrates the pathophysiological central hypoxemic origin of episodes of generalized weakness caused by a high-degree atrioventricular block in a patient surviving 29 years after heart transplant. It highlights the benefit of electroencephalography as a diagnostic tool in well-selected patients.
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Affiliation(s)
- Matthieu Raboud
- Department of Internal Medicine, University and Hospital of Fribourg, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| | - Andrea M. Humm
- Neurological Unit, Department of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Hari Vivekanantham
- Department of Cardiology, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Philipp Suter
- Department of Internal Medicine, University and Hospital of Fribourg, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland ,grid.5734.50000 0001 0726 5157Department of Pulmonary Medicine, University Hospital and University of Bern, Bern, Switzerland
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10
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Tai W, Doolittle GC, Shah Z, Atkinson JB, Russell E, Genton RE, Moslehi JJ, Porter CB. Immune-Checkpoint Inhibitor (ICI) resumption after severe graft injury in a heart transplant recipient with nivolumab-sensitive metastatic melanoma and renal cell carcinoma. J Heart Lung Transplant 2022; 41:1860-1864. [PMID: 36220718 PMCID: PMC10166596 DOI: 10.1016/j.healun.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Warren Tai
- Division of Cardiology, University of California, Los Angeles, California
| | - Gary C Doolittle
- Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Missouri
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Missouri
| | - James B Atkinson
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elaine Russell
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Missouri
| | - Randall E Genton
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Missouri
| | - Javid J Moslehi
- Division of Cardiology, Cardio-Oncology & Immunology Program, University of California, San Francisco, California
| | - Charles B Porter
- Department of Cardiovascular Medicine, Cardio-Oncology Program, University of Kansas Medical Center, Kansas City, Missouri.
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11
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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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12
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Leonelli FM, Ponti RD, Bagliani G. Interpretation of Typical and Atypical Atrial Flutters by Precision Electrocardiology Based on Intracardiac Recording. Card Electrophysiol Clin 2022; 14:435-458. [PMID: 36153125 DOI: 10.1016/j.ccep.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Atrial flutter is a term encompassing multiple clinical entities. Clinical manifestations of these arrhythmias range from typical isthmus-dependent flutter to post-ablation microreentries. Twelve-lead electrocardiogram (ECG) is a diagnostic tool in typical flutter, but it is often unable to clearly localize atrial flutters maintained by more complex reentrant circuits. Electrophysiology study and mapping are able to characterize in fine details all the components of the circuit and determine their electrophysiological properties. Combining these 2 techniques can greatly help in understanding the vectors determining the ECG morphology of the flutter waveforms, increasing the diagnostic usefulness of this tool.
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Affiliation(s)
- Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA; University of South Florida FL 4202 E Fowler Avenue, Tampa, FL 33620, USA.
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Giuseppe Bagliani
- Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy
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13
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Compagnucci P, Casella M, Bagliani G, Capestro A, Volpato G, Valeri Y, Cipolletta L, Parisi Q, Molini S, Misiani A, Russo AD. Atrial Flutter in Particular Patient Populations. Card Electrophysiol Clin 2022; 14:517-532. [PMID: 36153131 DOI: 10.1016/j.ccep.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
"Despite being one of the best understood cardiac arrhythmias, the clinical meaning of atrial flutter varies according to the specific context, and its optimal treatment may be limited by both the suboptimal response to rate/rhythm control drugs and by the complexity of the underlying substrate. In this article, we present a state-of-the-art overview of mechanisms, prognostic impact, and medical/interventional management options for atrial flutter in several specific patient populations, including heart failure, cardiomyopathies, muscular dystrophies, posttransplant patients, patients with respiratory disorders, athletes, and subjects with preexcitation, aiming to stimulate further research in this challenging field and facilitate appropriate patient care."
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Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Alessandro Capestro
- Department of Pediatric and Congenital Cardiology and Cardiac Surgery, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Quintino Parisi
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Silvano Molini
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Agostino Misiani
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
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14
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Minhas AMK, Mahmood Shah SM, Shahid I, Siddiqi TJ, Arshad MS, Jain V, Ullah W, Ahmad MM, Bhopalwala HM, Dewaswala N, Ijaz SH, Dani SS. Utilization of Implantable Cardioverter-Defibrillators in Patients With Heart Transplant (from National Inpatient Sample Database). Am J Cardiol 2022; 175:65-71. [PMID: 35595555 DOI: 10.1016/j.amjcard.2022.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
Heart transplant (HT) recipients represent a unique and vulnerable population in whom medium and long-term outcomes are significantly affected by the risk of arrhythmias and sudden cardiac death. The use of implantable cardioverter-defibrillators (ICDs) in this population remains debated. A retrospective analysis of the National Inpatient Sample data between 2009 and 2018 was conducted. Hospitalization data on patients who underwent HT, or who had a preexisting HT, and who received a new ICD were included (excluding the preexisting ICD). Outcomes assessed included inpatient mortality, length of stay, and inflation-adjusted costs. We explored temporal trends in ICD placement and mean length of stay, and predictors of ICD placement. Between 2009 and 2018, 22,673 hospitalizations were recorded for HT, during which patients either received a concurrent new ICD placement (n = 70 [0.31%]) or no new ICD placement (n = 22,603 [99.7%]). During the same period, 146,555 admissions were recorded in patients with a history of HT. ICD placement in patients with a preexisting HT was associated with significantly higher inflation-adjusted costs ($55,680.7 vs $17,219.2; p <0.001). Predictors of ICD placement in preexisting patients with HT included cardiac arrest during hospitalization (odds ratio [OR]:14.3 [3.5 to 58.6]), drug abuse (OR:6.0 [1.3 to 27.1]), and previous PCI (OR:6.0 [2.1 to 17.3]). In conclusion, ICD placement in patients with HT history was associated with significantly higher inflation-adjusted costs. In patients with HT history, factors predicting ICD placement included cardiac arrest at hospitalization, previous PCI, and drug abuse.
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Affiliation(s)
| | | | - Izza Shahid
- Ziauddin Medical University, Karachi, Pakistan
| | - Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Vardhman Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Waqas Ullah
- Division of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Mohsin M Ahmad
- Department of Internal Medicine, Merit Health Wesley, Hattiesburg, Mississippi
| | - Huzefa M Bhopalwala
- Department of Internal Medicine, Appalachian Regional Healthcare, Whitesburg, Kentucky
| | - Nakeya Dewaswala
- Department of Cardiovascular Disease, University of Kentucky, Lexington, Kentuck
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
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15
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Adult Renal Transplantation in a Patient 28 Years after Heart Transplantation as a Neonate for Hypoplastic Left Heart Syndrome. Case Rep Transplant 2022; 2022:7532199. [PMID: 35425650 PMCID: PMC9005266 DOI: 10.1155/2022/7532199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 11/24/2022] Open
Abstract
We present a case of kidney transplantation in a 28-year-old patient who received a heart transplant at 7 weeks of age due to hypoplastic left heart syndrome. The patient's renal insufficiency was the result of chronic immunosuppression and hypertension. The almost 28-year-old graft demonstrated very good function. This patient represents as one of the longest pediatric cardiac graft recipients living without any significant functional limitations.
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16
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Roest S, Manintveld OC, Kolff MAE, Akca F, Veenis JF, Constantinescu AA, Brugts JJ, Birim O, van Osch-Gevers LM, Szili-Torok T, Caliskan K. Cardiac allograft vasculopathy and donor age affecting permanent pacemaker implantation after heart transplantation. ESC Heart Fail 2022; 9:1239-1247. [PMID: 35174653 PMCID: PMC8934965 DOI: 10.1002/ehf2.13799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/27/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The need for permanent pacemakers (PMs) after heart transplantation (HT) is increasing. The aim was to determine the influence of cardiac allograft vasculopathy (CAV), donor age, and other risk factors on PM implantations early and late after HT and its effect on survival. Methods and results A retrospective, single‐centre study was performed including HTs from 1984 to July 2018. Early PM was defined as PM implantation ≤90 days and late PM as PM > 90 days. Risk factors for PM and survival after PM were determined with (time‐dependent) multivariable Cox regression. Out of 720 HTs performed, 62 were excluded (55 mortalities ≤30 days and 7 retransplantations). Of the remaining 658 patients, 95 (14%) needed a PM: 38 (6%) early and 57 (9%) late during follow‐up (median 9.3 years). Early PM risk factors were donor age [hazard ratio (HR) 1.06, P < 0.001], ischaemic time (HR 1.01, P < 0.001), and in adults amiodarone use before HT (HR 2.02, P = 0.045). Late PM risk factors were donor age (HR 1.03, P = 0.024) and CAV (HR 3.59, P < 0.001). Late PM compromised survival (HR 2.05, P < 0.001), while early PM did not (HR 0.77, P = 0.41). Conclusions Risk factors for early PM implantation were donor age, ischaemic time, and in adults amiodarone use before HT. Late PM implantation risk factors were donor age and CAV. Late PM diminished survival, which is probably a surrogate marker for underlying progressive cardiac disease.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marit A E Kolff
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ferdi Akca
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jesse F Veenis
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ozcan Birim
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lennie M van Osch-Gevers
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Division of Paediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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17
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Navarro-Navajas A, Cruz-Cuevas J, Bolívar Mejía A, Isaza D. [Trasplante cardiaco y bloqueo auriculoventricular tardío. Reporte de un caso]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:522-524. [PMID: 33268904 PMCID: PMC8641450 DOI: 10.24875/acm.20000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alberto Navarro-Navajas
- Servicio de Cardiología, Fundación Cardioinfantil Instituto de Cardiología, y Posgrado en Cardiología, Universidad El Bosque, Bogotá, Colombia
| | - José Cruz-Cuevas
- Servicio de Medicina Interna, Fundación Cardioinfantil, Instituto de Cardiología, y Posgrado de Medicina Interna, Universidad del Rosario, Bogotá, Colombia
| | - Adrián Bolívar Mejía
- Servicio de Medicina Interna, Clínica Cardio VID, y Posgrado de Cardiología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Daniel Isaza
- Dirección de Unidad de Cuidado Coronario, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá. Colombia
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18
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Darche FF, Helmschrott M, Rahm AK, Thomas D, Schweizer PA, Bruckner T, Ehlermann P, Kreusser MM, Warnecke G, Frey N, Rivinius R. Atrial fibrillation before heart transplantation is a risk factor for post-transplant atrial fibrillation and mortality. ESC Heart Fail 2021; 8:4265-4277. [PMID: 34453484 PMCID: PMC8497346 DOI: 10.1002/ehf2.13552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Atrial fibrillation (AF) after heart transplantation (HTX) is associated with worse clinical outcomes. The current study aimed to analyse the association between AF before HTX and AF within 30 days after HTX. METHODS AND RESULTS This study included 639 adults who received HTX at Heidelberg Heart Center. Patients were subdivided into four groups depending on the status of AF before and after HTX. Analyses comprised recipient and donor data, medication, echocardiographic features, permanent pacemaker implantation, stroke, and mortality after HTX. Three hundred thirty-two patients (52.0%) had neither AF before nor after HTX, 15 patients (2.3%) had no AF before HTX but showed AF after HTX, 219 patients (34.3%) showed AF before HTX but had no AF after HTX, and 73 patients (11.4%) had AF before and after HTX. Patients with AF before and after HTX had a higher 1 year post-transplant mortality (39.7%) than patients without AF before or after HTX (18.1%, P < 0.01). Secondary outcomes showed a higher percentage of enlarged atria, ventricular dysfunction, mitral regurgitation, 1-year stroke, and 1-year permanent pacemaker implantation in patients with AF before and after HTX. Multivariate analysis revealed a six-fold elevated risk for post-transplant AF in patients with AF before HTX (hazard ratio: 6.59, confidence interval: 3.72-11.65; P < 0.01). Further risk factors for post-transplant AF were higher donor age and prolonged ischaemic time, whereas total orthotopic HTX was associated with a two-fold lower risk for post-transplant AF. CONCLUSIONS Atrial fibrillation before HTX is a risk factor for post-transplant AF, permanent pacemaker implantation, and mortality after HTX.
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Affiliation(s)
- Fabrice F Darche
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Matthias Helmschrott
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Ann-Kathrin Rahm
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Patrick A Schweizer
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Tom Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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19
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Rahm AK, Helmschrott M, Darche FF, Thomas D, Bruckner T, Ehlermann P, Kreusser MM, Warnecke G, Frey N, Rivinius R. Newly acquired complete right bundle branch block early after heart transplantation is associated with lower survival. ESC Heart Fail 2021; 8:3737-3747. [PMID: 34213089 PMCID: PMC8497214 DOI: 10.1002/ehf2.13494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 01/06/2023] Open
Abstract
Aims Right bundle branch block (RBBB) after heart transplantation (HTX) is a common finding, but its impact on post‐transplant survival remains uncertain. This study investigated the post‐transplant outcomes of patients with complete RBBB (cRBBB) ≤ 30 days after HTX. Methods This registry study analysed 639 patients receiving HTX at Heidelberg Heart Center between 1989 and 2019. Patients were stratified by diagnosis of cRBBB ≤ 30 days after HTX. Analysis included recipient and donor data, medication, echocardiographic features, graft rejections, atrial fibrillation, heart rates, permanent pacemaker implantation and mortality after HTX including causes of death. Results One hundred thirty‐nine patients showed cRBBB ≤ 30 days after HTX (21.8%), 20 patients with pre‐existing cRBBB in the donor heart (3.2%) and 119 patients with newly acquired cRBBB (18.6%). Patients with newly acquired cRBBB had a worse 1‐year post‐transplant survival (36.1%, P < 0.01) compared with patients with pre‐existing cRBBB (85.0%) or without cRBBB (86.4%), along with a higher percentage of death due to graft failure (P < 0.01). Multivariate analysis indicated cRBBB ≤ 30 days after HTX as significant risk factor for 1‐year mortality after HTX (HR: 2.20; 95% CI: 1.68–2.87; P < 0.01). Secondary outcomes showed a higher rate of an enlarged right atrium (P = 0.01), enlarged right ventricle (P < 0.01), reduced right ventricular function (P < 0.01), 30‐day atrial fibrillation (P < 0.01) and 1‐year permanent pacemaker implantation (P = 0.02) in patients with cRBBB after HTX. Conclusions Newly acquired cRBBB early after HTX is associated with increased post‐transplant mortality.
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Affiliation(s)
- Ann-Kathrin Rahm
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Matthias Helmschrott
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Fabrice F Darche
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Tom Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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20
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Morillo J, García-Izquierdo Jaén E, Fernández Lozano I. Atrioventricular Dissociation in a Heart Transplant Recipient. JAMA Intern Med 2021; 181:544-545. [PMID: 33587089 DOI: 10.1001/jamainternmed.2020.8889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joel Morillo
- Arrhythmia Unit, Department of Cardiology, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | | | - Ignacio Fernández Lozano
- Arrhythmia Unit, Department of Cardiology, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
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21
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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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22
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Heart Transplantation From Brain Dead Donors: A Systematic Review of Animal Models. Transplantation 2021; 104:2272-2289. [PMID: 32150037 DOI: 10.1097/tp.0000000000003217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Despite advances in mechanical circulatory devices and pharmacologic therapies, heart transplantation (HTx) is the definitive and most effective therapy for an important proportion of qualifying patients with end-stage heart failure. However, the demand for donor hearts significantly outweighs the supply. Hearts are sourced from donors following brain death, which exposes donor hearts to substantial pathophysiological perturbations that can influence heart transplant success and recipient survival. Although significant advances in recipient selection, donor and HTx recipient management, immunosuppression, and pretransplant mechanical circulatory support have been achieved, primary graft dysfunction after cardiac transplantation continues to be an important cause of morbidity and mortality. Animal models, when appropriate, can guide/inform medical practice, and fill gaps in knowledge that are unattainable in clinical settings. Consequently, we performed a systematic review of existing animal models that incorporate donor brain death and subsequent HTx and assessed studies for scientific rigor and clinical relevance. Following literature screening via the U.S National Library of Medicine bibliographic database (MEDLINE) and Embase, 29 studies were assessed. Analysis of included studies identified marked heterogeneity in animal models of donor brain death coupled to HTx, with few research groups worldwide identified as utilizing these models. General reporting of important determinants of heart transplant success was mixed, and assessment of posttransplant cardiac function was limited to an invasive technique (pressure-volume analysis), which is limitedly applied in clinical settings. This review highlights translational challenges between available animal models and clinical heart transplant settings that are potentially hindering advancement of this field of investigation.
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Soto N, González-Casal D, Ávila P. Complete Atrioventricular Block Cured by Atrial Pacing?: Nothing Is What It Seems. Circulation 2021; 143:283-286. [PMID: 33464964 DOI: 10.1161/circulationaha.120.052500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nina Soto
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense and CIBERCV, Madrid, Spain
| | - David González-Casal
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense and CIBERCV, Madrid, Spain
| | - Pablo Ávila
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense and CIBERCV, Madrid, Spain
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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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Beukian S, Mahmood K, Anyanwu A, Miller M, Parikh A. A Tale of 2 Nodes After Orthotopic Heart Transplant. JACC Case Rep 2020; 2:1849-1851. [PMID: 34317065 PMCID: PMC8299243 DOI: 10.1016/j.jaccas.2020.07.063] [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: 05/12/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022]
Abstract
We report the case of a 30-year-old man who underwent orthotopic heart transplant via biatrial anastomosis technique. His post-operative electrocardiogram showed atrial dissociation, which is infrequently seen with newer surgical techniques in heart transplantation. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Sarine Beukian
- Department of Advanced Heart Failure and Transplant, Mount Sinai Hospital, New York, New York
| | - Kiran Mahmood
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marc Miller
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aditya Parikh
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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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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Parker VL, Parker WAE, Davies HM, Ramshaw HJ, D'Arcy EK, Al-Mohammad A, Mateszko O, Kew FM, Braidley PC. Benefits and Challenges of Robotic Pelvic Surgery in a Cardiac Transplant Recipient. Surg Innov 2020; 27:697-698. [PMID: 32525451 DOI: 10.1177/1553350620936007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Victoria L Parker
- Academic Unit of Reproductive and Developmental Medicine, 7315University of Sheffield, UK
| | - William A E Parker
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Holly M Davies
- 156677Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, UK
| | - Helen J Ramshaw
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Emma K D'Arcy
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Abdallah Al-Mohammad
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Olena Mateszko
- Department of Anaesthesia, Royal Hallamshire Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Fiona M Kew
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Peter C Braidley
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
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29
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Aceros H, Der Sarkissian S, Borie M, Pinto Ribeiro RV, Maltais S, Stevens LM, Noiseux N. Novel heat shock protein 90 inhibitor improves cardiac recovery in a rodent model of donation after circulatory death. J Thorac Cardiovasc Surg 2020; 163:e187-e197. [PMID: 32354629 DOI: 10.1016/j.jtcvs.2020.03.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/29/2020] [Accepted: 03/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Organ donation after circulatory death (DCD) is a potential solution for the shortage of suitable organs for transplant. Heart transplantation using DCD donors is not frequently performed due to the potential myocardial damage following warm ischemia. Heat shock protein (HSP) 90 has recently been investigated as a novel target to reduce ischemia/reperfusion injury. The objective of this study is to evaluate an innovative HSP90 inhibitor (HSP90i) as a cardioprotective agent in a model of DCD heart. METHODS A DCD protocol was initiated in anesthetized Lewis rats by discontinuation of ventilation and confirmation of circulatory death by invasive monitoring. Following 15 minutes of warm ischemia, cardioplegia was perfused for 5 minutes at physiological pressure. DCD hearts were mounted on a Langendorff ex vivo heart perfusion system for reconditioning and functional assessment (60 minutes). HSP90i (0.01 μmol/L) or vehicle was perfused in the cardioplegia and during the first 10 minutes of ex vivo heart perfusion reperfusion. Following assessment, pro-survival pathway signaling was evaluated by western blot or polymerase chain reaction. RESULTS Treatment with HSP90i preserved left ventricular contractility (maximum + dP/dt, 2385 ± 249 vs 1745 ± 150 mm Hg/s), relaxation (minimum -dP/dt, -1437 ± 97 vs 1125 ± 85 mm Hg/s), and developed pressure (60.7 ± 5.6 vs 43.9 ± 4.0 mm Hg), when compared with control DCD hearts (All P = .001). Treatment abrogates ischemic injury as demonstrated by a significant reduction of infarct size (2,3,5-triphenyl-tetrazolium chloride staining) of 7 ± 3% versus 19 ± 4% (P = .03), troponin T release, and mRNA expression of Bax/Bcl-2 (P < .05). CONCLUSIONS The cardioprotective effects of HSP90i when used following circulatory death might improve transplant organ availability by expanding the use of DCD hearts.
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Affiliation(s)
- Henry Aceros
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Shant Der Sarkissian
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Faculty of Medicine, Department of Surgery, Université de Montréal, Montréal, Canada
| | - Mélanie Borie
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Roberto Vanin Pinto Ribeiro
- Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Simon Maltais
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Louis-Mathieu Stevens
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Faculty of Medicine, Department of Surgery, Université de Montréal, Montréal, Canada
| | - Nicolas Noiseux
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Faculty of Medicine, Department of Surgery, Université de Montréal, Montréal, Canada.
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30
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Correa A, Rochlani Y, Aronow WS. Current pharmacotherapeutic strategies for cardiac arrhythmias in heart failure. Expert Opin Pharmacother 2020; 21:339-352. [PMID: 31928092 DOI: 10.1080/14656566.2019.1703950] [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] [Indexed: 12/27/2022]
Abstract
Introduction: Heart failure (HF) affects over 6 million Americans and is the most common cause of hospital readmissions in the United States. Cardiac arrhythmias are common comorbidities seen in patients with HF and are associated with an increase in morbidity and mortality. Pharmacotherapeutic agents along with device and ablation therapies are the mainstays of treatment for cardiac arrhythmias in HF.Areas covered: An extensive literature review of articles and clinical trials on PUBMED on the topic of pharmacotherapy for cardiac arrhythmias in heart failure was conducted. This review article summarizes the above literature to describe the prevalence of the various types of arrhythmias in HF, the recommended pharmacotherapies for the treatment of these arrhythmias in HF and the evidence that supports these recommendations.Expert opinion: Cardiac arrhythmias are common in HF and are the leading cause of death in this patient population. The management of cardiac arrhythmias in HF is challenging. Pharmacotherapy is the primary though increasingly adjunctive therapy for most cardiac arrhythmias. Further, antiarrhythmic drugs must be used with caution in this patient population due to their potential adverse effects.
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Affiliation(s)
- Ashish Correa
- Division of Cardiology, Mount Sinai St. Luke's and Mount Sinai West, New York, NY, USA
| | - Yogita Rochlani
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Shafaghi S, Naghashzadeh F, Sharif Kashani B, Behzadnia N, Ahmadi ZH. Atrioventricular Block: A Heralding Sign of Cardiac Allograft Rejection. Int J Organ Transplant Med 2020; 11:90-92. [PMID: 32832044 PMCID: PMC7430056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Heart transplantation is the treatment of choice for those with end-stage heart failure. However, despite improvements in immunosuppressive treatment, patients are at significant risk of allograft rejection, especially early after transplantation. Any changes in patient's heart condition including reduced left ventricular ejection fraction, arrhythmia and any types of blocks need attention. Herein we report on a 29-year-old man who underwent heart transplantation 5 years before due to dilated cardiomyopathy. He was on immunosuppressive therapy and was good until one week before his admission, when he felt palpitation. Electrocardiography during palpitation showed a second-degree AV-block with heart rate of 60 beats/min. Echocardiography showed good left ventricular systolic function with no regional wall motion abnormality. The patient referred for coronary angiography and endomyocardial biopsy. The angiography was normal. The biopsy showed rejection compatible with ISHLT grade 2R. After treating the patient with 1.5 g methylprednisolone, the symptoms relieved and the block resolved. Bradycardia and second-degree AV-block late after heart transplantation could be a sign of cardiac allograft rejection and need more evaluation, especially endomyocardial biopsy.
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Affiliation(s)
- S. Shafaghi
- Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F. Naghashzadeh
- Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran ,CORRESPONDENCE: FARAH NAGHASHZADEH, LUNG TRANSPLANT RESEARCH CENTER, NRITLD, SHAHID BEHESHTI UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN . TEL: +98-21-2712-2522, FAX: +98-21-2610-9484, E-mail:
| | - B. Sharif Kashani
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N. Behzadnia
- Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z. H. Ahmadi
- Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Waits G, Kim J. A Young Woman with Someone Else's Heart. Methodist Debakey Cardiovasc J 2020; 16:e8. [PMID: 32280426 PMCID: PMC7137629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- George Waits
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Ju Kim
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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Successful treatment of rejection-related atrial tachycardia with pulse steroid after heart transplantation. Anatol J Cardiol 2020; 25:205-208. [PMID: 33690136 DOI: 10.14744/anatoljcardiol.2020.64859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jin Y, Zhou T, Feng Q, Yang J, Cao J, Xu X, Yang C. Inhibition of MicroRNA-206 Ameliorates Ischemia-Reperfusion Arrhythmia in a Mouse Model by Targeting Connexin43. J Cardiovasc Transl Res 2019; 13:584-592. [PMID: 31792806 DOI: 10.1007/s12265-019-09940-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/15/2019] [Indexed: 01/10/2023]
Abstract
Reperfusion arrhythmias (RA) are an important cause of sudden cardiac death and is closely associated with gap junction protein in the heart, connexin 43 (Cx43). This study is aimed at elucidating the molecular association between microRNA-206 (miR-206) and Cx43 in ischemia-reperfusion arrhythmia using experimental animal model. Our results showed that miR-206 inhibitor alleviated ischemia-reperfusion-induced arrhythmias, indicated by the lower extent of changes in heart rate (HR), PR interval, rate pressure product (RPP), and mean arterial pressure (MAP). miR-206 inhibitor also downregulated the serum creatine kinase isoenzyme (CKMB) and cardiac troponin I (cTnI) levels in mice under myocardial ischemia-reperfusion (IR) process. The knockdown of Cx43 inversed the protective effects of miR-206 inhibitor on cardiac arrhythmias. These results supported that inhibition of miR-206 ameliorates ischemia-reperfusion arrhythmia by targeting Cx43, and this miR-206/Cx43 axis could serve as a potential target for the management of ischemic-perfusion arrhythmia.
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Affiliation(s)
- Yan Jin
- Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No. 68 Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Tianyi Zhou
- Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No. 68 Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Qiuting Feng
- Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No. 68 Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Jun Yang
- Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No. 68 Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Jianing Cao
- Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No. 68 Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Xin Xu
- Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No. 68 Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Chengjian Yang
- Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No. 68 Zhongshan Road, Wuxi, 214002, Jiangsu, China.
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Simonenko MA, Fedotov PA, Danilov IN, Salov MA, Sazonova YV, Monosova KI, Neymark AE, Sitnikova MY, Nikolaev GV, Gordeev ML, Karpenko MA. [Experience of general surgical procedures in patients after heart transplantation]. ACTA ACUST UNITED AC 2019; 59:57-63. [PMID: 31995726 DOI: 10.18087/10.18087/cardio.n623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To study the frequency of general surgical diseases development snd their features in patients after heart transplantation (HTx). METHODS From January 2010 to December 2018 it was performed 112 HTx (mean age - 46.7±14.0 years old; 82 - male, 30 - female). During 30 days after HTx 9 patients died. After discharge all recipients (n=98) were included in dispensary observation list. We retrospectively analyzed patients (n=35) who underwent general surgery manipulations in more than 30 days after HTx. All surgical interventions have been done under the reduction of immunosuppression therapy. RESULTS During 9 years of post-heart transplant follow-up 45 surgical interventions were performed, 7% (n=3) of them due to infectious complications, 31% (n=14) - oncology and others (62%, n=28). Most of manipulations were planned (39 from 45, 87%), the following general surgery interven- tions prevailed: laparoscopic cholecystectomy (n=13) and those to remove inguinal and umbilical hernia (n=12). During the 1st year the frequency of diseases required surgical treatment was 26% (n=11), infectious causes took place in 5 patients, non-infectious - in 6. Subsequently the incidence of infectious complications decreased that could be associated with the minimization of immunosuppressive therapy. Oncology was more frequent long-term after HTx - more than 3 years: among them the development of colon polyps prevailed and all recipients underwent polypectomy. There was no impact of age, gender, causes of chronic heart failure, obesity, immunosuppressive regimen (including the induction) on the frequency of general surgery diseases development (p>0.05). CONCLUSION Based on our experience, we proposed an algorithm of examination, the features of surgical tactics and preparation for it in heart transplanted recipients are described. The important role of post-heart transplant follow-up in the timely detection of diseases requiring general surgical care is given.
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Affiliation(s)
- M A Simonenko
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - P A Fedotov
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - I N Danilov
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - M A Salov
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - Yu V Sazonova
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - K I Monosova
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - A E Neymark
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - M Yu Sitnikova
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - G V Nikolaev
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - M L Gordeev
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
| | - M A Karpenko
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
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Bergau L, El-Hamriti M, Sommer P, Sohns C. Ablation of premature ventricular contractions in a transplanted human heart suffering from graft vasculopathy. Clin Res Cardiol 2019; 109:400-402. [PMID: 31511963 DOI: 10.1007/s00392-019-01542-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Mustapha El-Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
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37
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Conduction Abnormalities Associated with Tricuspid Annuloplasty in Cardiac Transplantation. ASAIO J 2019; 65:707-711. [DOI: 10.1097/mat.0000000000000873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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38
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Lai E, Ray R, Hongo R. Dual Sinus Nodes With Donor Sinus Node Dysfunction in Biatrial Heart Transplantation. JAMA Intern Med 2019; 179:975-976. [PMID: 31107496 DOI: 10.1001/jamainternmed.2019.0640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Everett Lai
- California Pacific Medical Center, San Francisco
| | - Ranjan Ray
- Department of Advanced Heart Failure and Transplant Cardiology, California Pacific Medical Center, San Francisco
| | - Richard Hongo
- Atrial Fibrillation and Complex Arrhythmia Center, California Pacific Medical Center, San Francisco
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39
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Shen T, Huh MH, Czer LS, Vaidya A, Esmailian F, Kobashigawa JA, Nurok M. Controversies in the Postoperative Management of the Critically Ill Heart Transplant Patient. Anesth Analg 2019; 129:1023-1033. [PMID: 31162160 DOI: 10.1213/ane.0000000000004220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Heart transplant recipients are susceptible to a number of complications in the immediate postoperative period. Despite advances in surgical techniques, mechanical circulatory support (MCS), and immunosuppression, evidence supporting optimal management strategies of the critically ill transplant patient is lacking on many fronts. This review identifies some of these controversies with the aim of stimulating further discussion and development into these gray areas.
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Affiliation(s)
- Tao Shen
- From the Departments of Anesthesiology.,Surgery, Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Lawrence S Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Ajay Vaidya
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Jon A Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Michael Nurok
- From the Departments of Anesthesiology.,Surgery, Cedars-Sinai Heart Institute, Los Angeles, California
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40
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Truby LK, DeRoo S, Spellman J, Jennings DL, Takeda K, Fine B, Restaino S, Farr M. Management of primary graft failure after heart transplantation: Preoperative risks, perioperative events, and postoperative decisions. Clin Transplant 2019; 33:e13557. [PMID: 30933386 DOI: 10.1111/ctr.13557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/30/2022]
Abstract
Primary graft failure (PGF) after heart transplantation (HT) is a devastating and unexpected event characterized by failure of the graft to adequately support recipient circulation necessitating high doses of vasopressors and inotropes and/or temporary mechanical circulatory support. Although it represents an increasingly common event in the current era, there remains a high degree of variability in prevalence, reported risk factors, and approach to this clinical entity. The purpose of the current review is to highlight preoperative considerations including known incidence and risk factors, perioperative issues involving the identification and management of PGF, and postoperative decisions related to weaning of mechanical circulatory support and titration of immunosuppressive therapy. Lastly, we highlight future directions in PGF research, involving basic and translational research, that have the potential to uncover novel strategies of risk stratification and treatment. CASE: Our patient is a 53-year-old man with end-stage non-ischemic dilated cardiomyopathy complicated by ventricular tachycardia (VT), post-capillary pulmonary hypertension, and renal insufficiency. After progressing to NYHA Class IV symptoms, he underwent implantation of a durable left ventricular assist device (LVAD) as bridge to transplant (BTT). On device support, he developed recurrent VT resulting in multiple defibrillator discharges and hospital admission for intravenous anti-arrhythmic therapy. He is subsequently upgraded to a higher status on the waiting list. A suitable donor is identified, with an appropriate predicted heart mass and an anticipated ischemic time of <4 hours. He is taken to the operating room, where at the time of anesthesia induction he develops vasodilatory shock, requiring high-dose vasopressors, and cardiopulmonary bypass (CPB) support for dissection. After surgical anastomosis, cross clamp removal and reperfusion, graft function is extremely poor, there is significant bradycardia requiring pacing, and the patient is unable to be weaned successfully from CPB. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is initiated, and the patient is transferred to the intensive care unit. Retrospective flow crossmatch is negative. This patient is suffering from severe primary graft failure.
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Affiliation(s)
- Lauren K Truby
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Scott DeRoo
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Jessica Spellman
- Department of Anesthesia, Columbia University Irving Medical Center, New York, New York
| | - Douglas L Jennings
- Department of Pharmacology, New York Presbyterian Hospital, New York, New York
| | - Koji Takeda
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Barry Fine
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Susan Restaino
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Maryjane Farr
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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41
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Upregulation of MMP-9 and CaMKII prompts cardiac electrophysiological changes that predispose denervated transplanted hearts to arrhythmogenesis after prolonged cold ischemic storage. Biomed Pharmacother 2019; 112:108641. [DOI: 10.1016/j.biopha.2019.108641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 11/20/2022] Open
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42
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Mahmood A, Andrews R, Fenton M, Morrison A, Mangat J, Davies B, Burch M, Simmonds J. Permanent pacemaker implantation after pediatric heart transplantation: Risk factors, indications, and outcomes. Clin Transplant 2019; 33:e13503. [DOI: 10.1111/ctr.13503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/18/2019] [Accepted: 01/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Adil Mahmood
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Rachel Andrews
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Alanna Morrison
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Jasveer Mangat
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Ben Davies
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Michael Burch
- Great Ormond Street Hospital for Children Foundation Trust London UK
| | - Jacob Simmonds
- Great Ormond Street Hospital for Children Foundation Trust London UK
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43
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Poulin MF, Mohamedali B, Kavinsky CJ, Krishnan K. Left atrial appendage occlusion using a Watchman device in a transplanted heart with biatrial anastomosis. Catheter Cardiovasc Interv 2019; 93:758-760. [PMID: 30549242 DOI: 10.1002/ccd.28027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/28/2018] [Accepted: 12/02/2018] [Indexed: 11/09/2022]
Abstract
A percutaneous left atrial appendage (LAA) occlusion using a Watchman device was performed in a patient with prior biatrial anastomosis orthotopic heart transplant (OHT). Due to the anatomical changes following biatrial anastomosis, transesophageal echocardiography (TEE) imaging and transseptal puncture become technically challenging. We describe how the standard LAA views on TEE were obtained for device sizing, and how the transseptal puncture was modified to cross the scarred septum. This case demonstrates that LAA occlusion using a Watchman device in biatrial anastomosis OHT is safe and can successfully be done.
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Affiliation(s)
- Marie-France Poulin
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Burhan Mohamedali
- Cardiovascular Institute of San Diego, 765 Medical Center, Chula Vista, California
| | - Clifford J Kavinsky
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Kousik Krishnan
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois
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44
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ISHLT Primary Graft Dysfunction Incidence, Risk Factors, and Outcome: A UK National Study. Transplantation 2019; 103:336-343. [DOI: 10.1097/tp.0000000000002220] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Makowiec D, Wdowczyk J, Struzik ZR. Heart Rhythm Insights Into Structural Remodeling in Atrial Tissue: Timed Automata Approach. Front Physiol 2019; 9:1859. [PMID: 30692928 PMCID: PMC6340163 DOI: 10.3389/fphys.2018.01859] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022] Open
Abstract
The heart rhythm of a person following heart transplantation (HTX) is assumed to display an intrinsic cardiac rhythm because it is significantly less influenced by the autonomic nervous system-the main source of heart rate variability in healthy people. Therefore, such a rhythm provides evidence for arrhythmogenic processes developing, usually silently, in the cardiac tissue. A model is proposed to simulate alterations in the cardiac tissue and to observe the effects of these changes on the resulting heart rhythm. The hybrid automata framework used makes it possible to represent reliably and simulate efficiently both the electrophysiology of a cardiac cell and the tissue organization. The curve fitting method used in the design of the hybrid automaton cycle follows the well-recognized physiological phases of the atrial myocyte membrane excitation. Moreover, knowledge of the complex architecture of the right atrium, the ability of the almost free design of intercellular connections makes the automata approach the only one possible. Two particular aspects are investigated: impairment of the impulse transmission between cells and structural changes in intercellular connections. The first aspect models the observed fatigue of cells due to specific cardiac tissue diseases. The second aspect simulates the increase in collagen deposition with aging. Finally, heart rhythms arising from the model are validated with the sinus heart rhythms recorded in HTX patients. The modulation in the impairment of the impulse transmission between cells reveals qualitatively the abnormally high heart rate variability observed in patients living long after HTX.
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Affiliation(s)
- Danuta Makowiec
- Institute of Theoretical Physics and Astrophysics, University of Gdańsk, Gdansk, Poland
| | - Joanna Wdowczyk
- 1st Department of Cardiology, Medical University of Gdańsk, Gdansk, Poland
| | - Zbigniew R Struzik
- RIKEN Advanced Center for Computing and Communication, Wako, Japan.,Graduate School of Education, University of Tokyo, Tokyo, Japan
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46
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Li WC, Gao H, Gao J, Wang ZJ. Antiarrhythmic effect of sevoflurane as an additive to HTK solution on reperfusion arrhythmias induced by hypothermia and ischaemia is associated with the phosphorylation of connexin 43 at serine 368. BMC Anesthesiol 2019; 19:5. [PMID: 30621602 PMCID: PMC6325883 DOI: 10.1186/s12871-018-0656-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/29/2018] [Indexed: 12/22/2022] Open
Abstract
Background Reperfusion ventricular arrhythmia (RA) associated with hypothermic ischaemic storage is increasingly recognized as a substantial contributor to adverse consequences after heart transplantation. Ischemia- or hypothermia-induced gap junction (GJ) remodelling is closely linked to RA. Reducing GJ remodelling contributes to RA attenuation and is important in heart transplantation. However, sevoflurane has an antiarrhythmic effect associated with the connexin 43 (Cx43) protein that has not yet been fully established. Methods Hearts were divided into two groups according to a random number table: all hearts were arrested by an infusion of histidine-tryptophan-ketoglutarate (HTK) solution (4 °C) followed by (1) storage in HTK solution (4 °C) alone for 6 h (n = 8, Control group) or (2) storage in HTK solution supplemented with sevoflurane (2.5%) (4 °C) for 6 h (n = 8, Sevo-HTK group). First, the total Cx43 level and the phosphorylation of Cx43 at Ser368 (Cx43-pS368) were assessed by Western blotting, and the distribution of Cx43 was assessed by immunohistochemistry. Second, programmed electrical stimulation (PES) and monophasic action potential (MAP) recording were used to analyse the MAP duration (MAPD), conduction velocity (CV) and transmural repolarization dispersion (TDR). In addition, haematoxylin and eosin (HE) and terminal deoxynucleotidyl transferase-dUTP nick end labelling (TUNEL) staining were individually used to investigate the degree of myocardial pathological damage and cell apoptosis. Finally, bipolar electrograms were used to record the graft re-beating time and monitor RA during reperfusion for 15 to 30 min. Results Sevo-HTK solution relatively increased the total Cx43 (P < 0.01) and Cx43-pS368 (P < 0.01) levels and prevented Cx43 redistribution (P < 0.05) and CV slowing (P < 0.001) but did not change TDR (P > 0.05). Additionally, the Cx43-pS368/total Cx43 ratio (P>0.05) was similar in the two groups. However, with Sevo-HTK solution, the graft re-beating times were shortened, myocardial pathological damage was ameliorated, and the number of apoptotic cells was markedly decreased. Conclusion The reduction in hypothermia and ischaemia-induced reperfusion arrhythmias by the addition of sevoflurane to HTK solution may be related to the phosphorylation of Cx43 at serine 368.
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Affiliation(s)
- Wei Chao Li
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Hong Gao
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
| | - Ju Gao
- Department of Anaesthesiology, North Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
| | - Zi Jun Wang
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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47
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Hu WS, Lin CL. Risk of new-onset atrial fibrillation among heart, kidney and liver transplant recipients: insights from a national cohort study. Intern Emerg Med 2019; 14:71-76. [PMID: 30255466 DOI: 10.1007/s11739-018-1950-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/13/2018] [Indexed: 12/18/2022]
Abstract
The objective of the study was to explore the incidence of atrial fibrillation (AF) in various populations of patients with organ transplantation (OT). We used a large national data set from Taiwan to investigate the incidence of AF after OT. Frequency matching method used to match controls: OT patients were 4:1. Kaplan-Meier analyses with the use of the Aalen-Johansen estimator was employed for estimating the cumulative incidences of new-onset AF. The Fine-Gray competing risks model was also employed to analyze the risk of AF for the OT cohort compared with the non-OT cohort. 6955 OT patients and 27,820 controls were included in this study. OT did lead to a 3.09-fold risk for AF [95% confidence interval (CI) = 2.07-4.62], especially in the subgroup of female gender [adjusted subhazard ratio (aSHR) = 6.66, 95% CI = 3.85-11.5], age ≤ 49 years (aSHR = 8.19, 95% CI = 3.99-16.8) and without comorbidity (aSHR = 4.61, 95% CI = 2.71-7.87). Moreover, liver recipients tended to be more likely to develop new-onset AF among those OT patients (aSHR = 4.07, 95% CI = 2.63-6.30) as compared to the controls. This study demonstrates an increased incidence of AF after OT. Heightened awareness and clinician vigilance are warranted to facilitate early diagnosis and improved outcomes.
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Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung, 40402, Taiwan.
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan
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48
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Chadda KR, Ajijola OA, Vaseghi M, Shivkumar K, Huang CLH, Jeevaratnam K. Ageing, the autonomic nervous system and arrhythmia: From brain to heart. Ageing Res Rev 2018; 48:40-50. [PMID: 30300712 DOI: 10.1016/j.arr.2018.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/21/2018] [Accepted: 09/30/2018] [Indexed: 02/08/2023]
Abstract
An ageing myocardium possesses significant electrophysiological alterations that predisposes the elderly patient to arrhythmic risk. Whilst these alterations are intrinsic to the cardiac myocytes, they are modulated by the cardiac autonomic nervous system (ANS) and consequently, ageing of the cardiac ANS is fundamental to the development of arrhythmias. A systems-based approach that incorporates the influence of the cardiac ANS could lead to better mechanistic understanding of how arrhythmogenic triggers and substrates interact spatially and temporally to produce sustained arrhythmia and why its incidence increases with age. Despite the existence of physiological oscillations of ANS activity on the heart, pathological oscillations can lead to defective activation and recovery properties of the myocardium. Such changes can be attributable to the decrease in functionality and structural alterations to ANS specific receptors in the myocardium with age. These altered ANS adaptive responses can occur either as a normal ageing process or accelerated in the presence of specific cardiac pathologies, such as genetic mutations or neurodegenerative conditions. Targeted intervention that seek to manipulate the ageing ANS influence on the myocardium may prove to be an efficacious approach for the management of arrhythmia in the ageing population.
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Affiliation(s)
- Karan R Chadda
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, United Kingdom; Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, UCLA Health System/David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System/David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System/David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher L-H Huang
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom; Department of Biochemistry, Hopkins Building, University of Cambridge, Cambridge, CB2 1QW, United Kingdom
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, United Kingdom; Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom.
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49
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Chokesuwattanaskul R, Bathini T, Thongprayoon C, Preechawat S, O'Corragain OA, Pachariyanon P, Ungprasert P, Cheungpasitporn W. Atrial fibrillation following heart transplantation: A systematic review and meta-analysis of observational studies. J Evid Based Med 2018; 11:261-271. [PMID: 30444058 DOI: 10.1111/jebm.12323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/22/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Previous studies have suggested a high incidence of atrial fibrillation (AF) in heart transplant recipients. However, incidence trends of AF in heart transplant recipients remain unclear. The study's aims were (1) to investigate the pooled incidence/incidence trends of AF following heart transplantation and (2) to assess the mortality risk of heart transplant recipients with AF. METHODS A literature search for studies that reported the incidence of AF following heart transplantation was conducted using MEDLINE, EMBASE, and The Cochrane Database from inception through March 2018. Pooled incidence and odds ratios (OR) with 95%CI were calculated using a random-effects model. RESULTS Eighteen studies (2 cohorts from clinical trials and 16 cohort studies) with 5393 heart transplant recipients were enrolled. The pooled estimated incidence of AF in heart transplant was 10.1% (95%CI: 7.6%-13.2%). Meta-analysis based on the type of anastomotic technique demonstrated a pooled estimated incidence of AF following heart transplantation of 18.7% (95%CI: 10.3%-31.5%) and 11.1% (95%CI: 6.5%-18.4%) by biatrial and bicaval techniques, respectively. There was a significant association between AF following a heart transplant and increased mortality risk with a pooled OR of 2.86 (95%CI: 2.08-3.93). Meta-regression analyses showed no significant correlations between the year of study and incidence of AF (P = 0.47) or mortality risk of AF after heart transplantation (P = 0.99). CONCLUSIONS The overall estimated incidence of AF following heart transplantation is 10.1%. There is a significant association between AF and increased mortality after transplantation. Furthermore, incidence and mortality risk of AF following heart transplant does not seem to decrease over time.
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Affiliation(s)
- Ronpichai Chokesuwattanaskul
- Faculty of Medicine, Division of Cardiology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Somchai Preechawat
- Faculty of Medicine, Division of Cardiology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Oisin A O'Corragain
- Department of Internal Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Pavida Pachariyanon
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Patompong Ungprasert
- Clinical Epidemiology Unit, Faculty of Medicine Siriraj Hospital, Department of Research and Development, Mahidol University, Bangkok, Thailand
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Mississippi, USA
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50
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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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