1
|
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.
Collapse
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
| |
Collapse
|
2
|
Mouhoub Y, Laredo M, Varnous S, Leprince P, Waintraub X, Gandjbakhch E, Hébert JL, Frank R, Maupain C, Pavie A, Hidden-Lucet F, Duthoit G. Catheter ablation of organized atrial arrhythmias in orthotopic heart transplantation. J Heart Lung Transplant 2017; 37:S1053-2498(17)31924-1. [PMID: 28784326 DOI: 10.1016/j.healun.2017.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Organized atrial arrhythmias (OAAs) are common after orthotopic heart transplantation (OHT). Some controversies remain about their clinical presentation, relationship with atrial anastomosis and electrophysiologic features. The objectives of this retrospective study were to determine the mechanisms of OAAs after OHT and describe the outcomes of radiofrequency catheter ablation (RFCA). METHODS Thirty consecutive transplanted patients (mean age 48 ± 17 years, 86.6% male) underwent 3-dimensional electroanatomic mapping and RFCA of their OAA from 2004 to 2012 at our center. RESULTS Twenty-two patients had biatrial anastomosis and 8 had bicaval anastomosis. Macro-reentry was the arrhythmia mechanism for 96% of patients. The electrophysiologic diagnoses were: cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) in 93% of patients (n = 28); perimitral AFL in 3% (n = 1); and focal atrial tachycardia (FAT) in 3% (n = 1). In 5 patients with biatrial anastomosis, a right FAT was inducible. Primary RFCA success was obtained in 93% of patients. Mean follow-up time was 39 ± 26.8 months. Electrical repermeation between recipient and donor atria, present in 20% of patients (n = 6), did not account for any of the OAAs observed. Survival without OAA relapse at 12, 24 and 60 months was 93%, 89% and 79%, respectively. CONCLUSIONS CTI-dependent AFL accounted for most instances of OAA after OHT, regardless of anastomosis type. Time from transplantation to OAA was shorter with bicaval than with biatrial anastomosis. RFCA was safe and provided good long-term results.
Collapse
Affiliation(s)
- Yamina Mouhoub
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Mikael Laredo
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Shaida Varnous
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pascal Leprince
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Xavier Waintraub
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Estelle Gandjbakhch
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Louis Hébert
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Robert Frank
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Carole Maupain
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain Pavie
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Guillaume Duthoit
- Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| |
Collapse
|
3
|
Jin Q, Pehrson S, Jacobsen PK, Chen X. Mapping strategy for multiple atrial tachyarrhythmias in a transplant heart. BMC Cardiovasc Disord 2015; 15:38. [PMID: 25964112 PMCID: PMC4443606 DOI: 10.1186/s12872-015-0031-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Different atrial arrhythmias can coexist in the recipient and donor atria after heart transplantation. Case presentation We report an unusual case of a patient with three different types of atrial arrhythmia after heart transplantation: an atrial fibrillation in the recipient atria, and a cavotricuspid isthmus dependent atrial flutter and a focal atrial tachycardia in the donor atria. 3D electroanatomical mapping and ablation were guided by remote magnetic navigation (RMN). Atrial fibrillation continued in the recipient atria even after the donor heart was converted to sinus rhythm by ablation. Conclusions It is critical to understand the surgical anatomy of a bi-atrial anastomosis and its relevant electrical activation pattern before ablation. Appropriate electroanatomical mapping strategy with RMN can facilitate the successful ablation of post-transplant atrial arrhythmias.
Collapse
Affiliation(s)
- Qi Jin
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. .,Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Steen Pehrson
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Peter Karl Jacobsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Xu Chen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|