Radiofrequency catheter ablation for atrial flutter following orthotopic heart transplantation

Abstract

A 26 year old woman with a diagnosis of limb girdle muscular dystrophy and peripartum cardiomyopathy underwent orthotopic heart transplantation using standard atrial anastomoses. Recurrent atrial flutter was demonstrated in the absence of histological evidence of cellular rejection. Radiofrequency ablation of the flutter circuit was successfully performed allowing the avoidance of long term antiarrhythmic therapy. Ten weeks following ablation and cessation of amiodarone, presyncopal symptoms were found, associated with daytime and nocturnal sinus pauses of 2.9 seconds and 4.2 seconds, respectively. There was no evidence of AV node conduction impairment. In view of the continued absence of cellular rejection and the evident denervated state of the heart, the pauses reflected significant donor sinus node dysfunction; therefore, an AAIR permanent pacing system was implanted. At the time of pacemaker implantation atrial pacing at 150 beats/ min did not produce significant PR interval prolongation or AV block. This case serves to advise rigorous follow up in such patients to continue to seek evidence of sinus node dysfunction potentially requiring permanent pacemaker implantation. (Heart 1998;79:412-413)

Mechanism of Atrial Flutter Occurring Late After Orthotopic Heart Transplantation with Atrio‐atrial Anastomosis

“…Mapping and ablation of atrial flutter in cardiac transplant recipients using conventional electrophysiologic criteria have been previously reported in single case reports 5–7 and a case series 8 . Electroanatomic mapping of transplant‐associated atrial flutter has been reported in single case reports 1,9,10 and one smaller case series 11 .…”

Catheter Ablation of Atrial Flutter after Orthotopic Heart Transplantation

“…This study suggested a flutter circuit involving macroreentry around the tricuspid annulus, but the study did not involve detailed electroanatomic mapping of the flutter circuit or ablation of the arrhythmia in the patients. Publications describing successful atrial flutter ablation in transplanted hearts have been limited to single case reports 5–12 . Here we describe detailed electroanatomic mapping and radiofrequency catheter ablation in three patients with right atrial flutter that occurred 8 to 10 years after orthotopic heart transplantation.…”

Arrhythmias after pediatric lung transplantation

“…This finding is analogous to the proposed mechanism of supraventricular tachyarrhythmias in patients who have undergone extensive atrial surgery for congenital heart disease, such as some forms of the modified Fontan operation, and atrial switch procedures (Mustard or Senning operations) (1–5). In transplanted hearts, where there may be both right and left atrial suture lines, atrial flutter has been noted, mapped to the right atrium, and successfully treated with radiofrequency ablation (11–13). A comparison of patients who had a right atrial anastomosis to those who had bicaval anastomoses for heart Tx yielded a significantly higher incidence of atrial arrhythmias in the group that underwent right atrial anastomosis: only one patient in the bicaval anastomosis group (n = 30) had an atrial arrhythmia, whereas 12 patients in the right atrial anastomosis group (n = 30) had atrial arrhythmias during the follow‐up period (14).…”