Document Detail


Supraventricular tachycardia after orthotopic cardiac transplantation.
MedLine Citation:
PMID:  18534271     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to define the incidence, mechanisms, and management, including catheter ablation, of supraventricular tachycardia (SVT) in a large series of patients after orthotopic heart transplantation (OHT). BACKGROUND: Supraventricular arrhythmias are frequently encountered after OHT, but their characteristics in this population have not been well established. METHODS: We analyzed the incidence, clinical course, and management of SVTs in a cohort of 729 adult patients who underwent OHT. Furthermore, the mechanisms of arrhythmias among the patients referred for electrophysiological study (EPS) and ablation were also characterized. RESULTS: The most common arrhythmia was atrial flutter, which occurred in 9% of this cohort. Persistent or paroxysmal atrial fibrillation occurred in 7%, the majority (57%) in the perioperative period. Persistent or paroxysmal atrial fibrillation was observed in OHT patients, beyond the post-operative period, only in the presence of rejection or transplant vasculopathy. Other persistent or paroxysmal SVTs were seen in 47 stable OHT patients (7%). Of these, 24 patients (4%) underwent EPS. Accessory and dual atrioventricular nodal pathways in the donor heart caused SVT in 3 patients. Macro-reentrant atrial tachycardia was seen in 7 patients, and isthmus-dependent atrial flutter occurred in 14 patients. CONCLUSIONS: The majority of SVTs in stable OHT patients can be attributed to macro-reentrant tachycardias (flutter and scar reentry). Catheter ablation is effective in management of these SVTs. Atrial fibrillation was never encountered in stable patients in our series, and its occurrence should prompt an evaluation for acute rejection and/or vasculopathy.
Authors:
Marmar Vaseghi; Noel G Boyle; Rohit Kedia; Jignesh K Patel; David A Cesario; Isaac Wiener; Jon A Kobashigawa; Kalyanam Shivkumar
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  51     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-06     Completed Date:  2008-07-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2241-9     Citation Subset:  AIM; IM    
Affiliation:
UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA.
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / etiology
Catheter Ablation*
Female
Heart Rate
Heart Transplantation / adverse effects*,  methods
Humans
Incidence
Male
Middle Aged
Retrospective Studies
Risk Factors
Tachycardia, Supraventricular / etiology*,  mortality,  physiopathology,  therapy
Time Factors
Grant Support
ID/Acronym/Agency:
R01HL084261/HL/NHLBI NIH HHS

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