Efficacy of Signal-Averaged Electrocardiography in the Young Orthotopic Heart Transplant Patient to Detect Allograft Rejection

Horenstein, Mariano; Idriss, Salim F.; Hamilton, Robert M.; Kanter, Ronald J.; Webster, Paul; Karpawich, Peter P.

doi:10.1007/s00246-005-1155-5

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…Severe ACAR was associated with a significant decrease in both peak and root-mean-square QRS complex amplitude in two studies, including 45 patients undergoing over 300 biopsies, although these parameters were insensitive to less severe ACAR 67 68. Data regarding other SAECG measurements, including the root-mean-square amplitude of the terminal 40 ms of the QRS complex, QRS duration and the presence of late potentials, are discordant, as are the results of studies assessing frequency domain analysis 67 69 70…”

Section: Electrophysiological Monitoringmentioning

confidence: 98%

Non-invasive approaches for the diagnosis of acute cardiac allograft rejection

Miller

Fildes

Ray

et al. 2012

Heart

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Despite modern immunosuppressive regimes, acute rejection remains a leading cause of morbidity and mortality in heart transplant recipients. Clinical features are unreliable, and therefore, screening is performed in order to detect rejection, and hence, augment immunosuppressive therapy, at an early stage, with the aim of reducing short- and long-term sequelae. Histological analysis of right ventricular myocardial tissue obtained at endomyocardial biopsy remains the 'gold standard' surveillance technique; however 'biopsy-negative' rejection occurs in up to 20% of patients, the procedure is associated with uncommon but potentially serious complications and it is expensive. Non-invasive screening would, conceivably, be safer, more tolerable and cheaper, and could potentially allow more comprehensive monitoring. The evidence for non-invasive methods of diagnosing acute rejection, including assessment of myocardial deformation, myocardial tissue characterisation, electrophysiological monitoring, visualisation of cellular and molecular components of rejection and peripheral monitoring of immune activation, is reviewed.

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Section: Electrophysiological Monitoringmentioning

confidence: 98%

Non-invasive approaches for the diagnosis of acute cardiac allograft rejection

Miller

Fildes

Ray

et al. 2012

Heart

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“…Signal‐averaged electrocardiography (SAECG) can demonstrate slowly conducting myocardium with delayed depolarization, potentially identifying areas of diseased myocardium. In 2006, Horenstein et al published their findings that SAECG was not able to differentiate between HT recipients with and without rejection 77 …”

Section: Non‐invasive Methods To Detect Asymptomatic Rejectionmentioning

confidence: 99%

Rejection surveillance in pediatric heart transplant recipients: Critical reflection on the role of frequent and long‐term routine surveillance endomyocardial biopsies and comprehensive review of non‐invasive rejection screening tools

Power

Hernandez

Dipchand

2022

Pediatric Transplantation

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Background Despite significant medical advances in the field of pediatric heart transplantation (HT), acute rejection remains an important cause of morbidity and mortality. Endomyocardial biopsy (EMB) remains the gold‐standard method for diagnosing rejection but is an invasive, expensive, and stressful process. Given the potential adverse consequences of rejection, routine post‐transplant rejection surveillance protocols incorporating EMB are widely employed to detect asymptomatic rejection. Each center employs their own specific routine rejection surveillance protocol, with no consensus on the optimal approach and with high inter‐center variability. The utility of high‐frequency and long‐term routine surveillance biopsies (RSB) in pediatric HT has been called into question. Methods Sources for this comprehensive review were primarily identified through searches in biomedical databases including MEDLINE and Embase. Results The available literature suggests that the diagnostic yield of RSB is low beyond the first year post‐HT and that a reduction in RSB intensity from high‐frequency to low‐frequency can be done safely with no impact on early and mid‐term survival. Though there are emerging non‐invasive methods of detecting asymptomatic rejection, the evidence is not yet strong enough for any test to replace EMB. Conclusion Overall, pediatric HT centers in North America should likely be doing fewer RSB than are currently performed. Risk factors for rejection should be considered when designing the optimal rejection surveillance strategy. Noninvasive testing including emerging biomarkers may have a complementary role to aid in safely reducing the need for RSB.

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“…Conduction delay contributed to ventricular dyssynchrony, regardless of LVPs in patients with heart failure, and LVPs did not play an important role in ventricular dyssynchrony [16]. Several SAECG studies have been performed in patients who underwent heart transplant [20][21][22]. SAECG distinguished between heart transplant patients with or without rejection, especially LAS40 and RMS40 [22].…”

Section: Late Ventricular Potentialsmentioning

confidence: 99%

“…The association between LVPs and rejection of heart transplant is explained by occurrence of areas of myocardial ibrosis, due to cell changes caused by alloreactive T lymphocytes against graft antigens and ischemia-reperfusion injuries as soon as the blood low is reestablished [22]. 20 young heart transplant patients SAECG is not efective in detecting heart transplant rejection in young patients Horenstein et al [21] Extracardiac disorders were also associated with LVPs, especially hypertension, metabolic syndrome, obesity, eating disorders, diabetes mellitus, renal failure, chronic obstructive pulmonary disease (COPD), acromegaly, thalassemia, connective tissue diseases, epilepsy, and schizophrenia [6,[23][24][25][26][27]. Antiarrhythmic therapy, thrombolytic drugs, statins, steroids, and coronary interventions may inluence LVPs [6].…”

Section: Late Ventricular Potentialsmentioning

confidence: 99%

Signal-Averaged ECG: Basics to Current Issues

Mozoş¹,

Stoian²

2017

Interpreting Cardiac Electrograms - From Skin to Endocardium

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Signal-averaged ECG (SAECG) is a high-resolution, noninvasive electrocardiographic method enabling detection of late ventricular potentials (LVP), which are low-amplitude and high-frequency signals, predicting reentry ventricular arrhythmias, and sudden cardiac death (SCD). Three criteria are used to detect late ventricular potentials as follows: signal-average ECG QRS duration (SAECG-QRS), the duration of the terminal part of the QRS complex with an amplitude below 40 μV (LAS40) and the root mean square (RSM) signal amplitude of the last 40 ms of the signal < 20 μV (RMS40). Late ventricular potentials can be detected not only at the end of a QRS complex but also as intra-QRS (IQRS) potentials. Signal-averaged ECG was modiied to enable the analysis of the P-wave and to detect atrial late potentials (ALPs), low-amplitude potentials at the terminal part of the iltered P-wave, and predictors of atrial ibrillation (AF). Late atrial and ventricular potentials originate from areas of delayed, fragmented, and heterogenous conduction within atrial or ventricular myocardium. This chapter reviews the most important mechanisms explaining the occurrence of late ventricular, intra-QRS, and atrial potentials; their predictive value for arrhythmia, focusing on recent clinical data, long-term follow-up, and outcome; and analysis of SAECG variables in cardiac and noncardiac diseases.

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Efficacy of Signal-Averaged Electrocardiography in the Young Orthotopic Heart Transplant Patient to Detect Allograft Rejection

Cited by 6 publications

References 33 publications

Non-invasive approaches for the diagnosis of acute cardiac allograft rejection

Non-invasive approaches for the diagnosis of acute cardiac allograft rejection

Rejection surveillance in pediatric heart transplant recipients: Critical reflection on the role of frequent and long‐term routine surveillance endomyocardial biopsies and comprehensive review of non‐invasive rejection screening tools

Signal-Averaged ECG: Basics to Current Issues

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