Natural history, determinants, and clinical relevance of conduction abnormalities following orthotopic heart transplantation

Leonelli, Fabio M.; Dunn, Jonathan; Young, James B.; Pacifico, Antonio

doi:10.1016/s0002-9149(97)89133-3

Cited by 26 publications

(29 citation statements)

References 18 publications

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“…Indeed, patients who died from SCD had similar LVEF (48 %) to patients who died from non-SCD, which is not surprising considering that most patients died from asystole and not from VF. This is consistent with the cohort study of Leonelli et al 36 involving 89 patients, in which all five who died from SCD belonged to the group of patients with ECG evidence of progressive conduction system damage during follow-up (i.e. a new hemiblock or complete bundle branch block), of which two were directly related to bradycardia.…”

Section: Sudden Cardiac Deathsupporting

confidence: 91%

Arrhythmias in the Heart Transplant Patient

Hamon

Taleski

Vaseghi

et al. 2014

Arrhythm Electrophysiol Rev

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Orthotopic heart transplantation (OHT) is the most effective long-term therapy for end-stage heart disease, with implanted left ventricular assist devices ('destination therapy') as an alternative for selected patients. The denervation of the transplanted heart with complete loss of autonomic nervous system modulation, the use of immunosuppressant drugs, as well as the risk of allograft rejection (AR) and vasculopathy, all change the incidence, prognosis and treatment of tachyarrhythmias and bradyarrhythmias, as well as the mechanisms of sudden cardiac death (SCD).Arrhythmias post-OHT can be classified according to their underlying mechanisms (see Table 1). Tachyarrhythmias and bradyarrythmias can come from the transplanted heart, be due to the surgery itself or result from AR or vasculopathy. In addition, bradyarrhythmias may be caused by drugs taken by the recipient patient before surgery. This review aims to present the most common causes of arrhythmias in OHT patients, and to highlight the importance of ruling out and treating AR and vasculopathy -transplant coronary artery disease (TCAD), which should always be the first concern. The causative mechanisms represent different risk factors, and overlap is possible, which may increase the occurrence of such arrhythmias.With the increasing success of radiofrequency (RF) ablation techniques, it is important that cardiologists are familiar with tachycardias and bradycardias in this context, which may benefit from a multidisciplinary approach in the management of the patient starting with the underlying mechanisms. Tachyarrhythmias Supraventricular TachycardiaThe most common atrial arrhythmia in OHT patients is atrial flutter AbstractOrthotopic heart transplantation (OHT) is currently the most effective long-term therapy for patients with end-stage cardiac disease, even as left ventricular devices show markedly improved outcomes. As surgical techniques and immunosuppressive regimens have been refined, short-term mortality caused by sepsis has decreased, while morbidity caused by repeated rejection episodes and vasculopathy has increased, and is often manifested by arrhythmias. These chronic transplant complications require early and aggressive multidisciplinary treatment. Understanding the relationship between arrhythmias and these complications in the acute and chronic stages following OHT is critical in improving patient prognosis, as arrhythmias may be the earliest or sole presentation. Finally, decentralised/ denervated hearts represent a unique opportunity to investigate the underlying mechanisms of arrhythmias.

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Section: Sudden Cardiac Deathsupporting

confidence: 91%

Arrhythmias in the Heart Transplant Patient

Hamon

Taleski

Vaseghi

et al. 2014

Arrhythm Electrophysiol Rev

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“…In a study by Patel et al [488] , who investigated 257 patient deaths, SCD had an incidence of 9·7% where 20% died <12 months after transplantation. There is a consensus that both bradyarrhythmias and tachyarrhythmias, due either to sinus node dysfunction or to complete heart block, are implicated in the early deaths [489] .…”

Section: Specific Conditions Of Sinus Node and Conduction Disturbancementioning

confidence: 99%

Task Force on Sudden Cardiac Death of the European Society of Cardiology

Priori

Aliot

Blomström‐Lundqvist

et al. 2001

European Heart Journal

768

445

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“…Several small studies report widely varying numbers of patients (0.5% to 15%) experiencing SCD after cardiac transplantation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] The cause of sudden death after heart transplantation is multifactorial with possible contributions from graft injury and ischemic triggers. 16 In the first year after transplantation, SCD usually occurs in the setting of acute rejection.…”

mentioning

confidence: 99%

“…Limited reports from the literature suggest that ventricular tachyarrhythmias may be a common mechanism of sudden death in either setting. 2,[17][18][19][20] …”

mentioning

confidence: 99%

The Efficacy of Implantable Cardioverter-Defibrillators in Heart Transplant Recipients

Tsai

Cooper

Garan

et al. 2009

Circ: Heart Failure

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Background-Sudden cardiac death among orthotopic heart transplant recipients is an important mechanism of death after cardiac transplantation. The role for implantable cardioverter-defibrillators (ICDs) in this population is not well established. This study sought to determine whether ICDs are effective in preventing Sudden cardiac death in high-risk heart transplant recipients. Methods and Results-We retrospectively analyzed the records of all orthotopic heart transplant patients who had ICD implantation between January 1995 and December 2005 at 5 heart transplant centers. Thirty-six patients were considered high risk for sudden cardiac death. The mean age at orthotopic heart transplant was 44Ϯ14 years, the majority being male (nϭ29). The mean age at ICD implantation was 52Ϯ14 years, whereas the average time from orthotopic heart transplant to ICD implant was 8 years Ϯ6 years. The main indications for ICD implantation were severe allograft vasculopathy (nϭ12), unexplained syncope (nϭ9), history of cardiac arrest (nϭ8), and severe left ventricular dysfunction (nϭ7). Twenty-two shocks were delivered to 10 patients (28%), of whom 8 (80%) received 12 appropriate shocks for either rapid ventricular tachycardia or ventricular fibrillation. The shocks were effective in terminating the ventricular arrhythmias in all cases. Three (8%) patients received 10 inappropriate shocks. Underlying allograft vasculopathy was present in 100% (8 of 8) of patients who received appropriate ICD therapy. Conclusions-Use of ICDs after heart transplantation may be appropriate in selected high-risk patients. Further studies are needed to establish an appropriate prevention strategy in this population. (Circ Heart Fail. 2009;2:197-201.)

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Natural history, determinants, and clinical relevance of conduction abnormalities following orthotopic heart transplantation

Cited by 26 publications

References 18 publications

Arrhythmias in the Heart Transplant Patient

Arrhythmias in the Heart Transplant Patient

Task Force on Sudden Cardiac Death of the European Society of Cardiology

The Efficacy of Implantable Cardioverter-Defibrillators in Heart Transplant Recipients

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