Radiofrequency Catheter Ablation of Atrial Flutter After Orthotopic Heart Transplantation

Abstract

This is the first report of successful radiofrequency catheter ablation of atrial flutter in a transplanted heart. Although mapping of the arrhythmia is more difficult due to the large circumference of the right atrium, which consists of parts of the recipient right atrium and the transplanted atrium, ablation should be considered in those patients with drug refractory supraventricular tachyarrhythmias.

Recipient Atrial Flutter Masquerading as Donor Flutter in a Heart Transplant Recipient

“…[7][8][9][10][11][12][13] It should be noted, however, that this particular form of flutter can only occur in transplant patients receiving bi-atrial anastomosis, which has been the standard anastomosis technique for years. More than 97% of patients reported by Ahmari et al 15 had bi-atrial anastomosis.…”

“…6 Successful catheter ablation of atrial flutter in this population has been reported on several occasions by radio-frequency application to the isthmus between the tricuspid valve and the atrial anastomosis adjacent to the inferior vena cava. [7][8][9][10][11][12][13] This is, however, not the usual initial therapeutic modality and such patients are started on antiarrhythmic drugs and anti-coagulation. 14 Herein we report the case of an OHT patient who developed atrial flutter on the surface electrocardiogram (ECG), resistant to conservative management and later underwent basic electrophysiologic (EP) evaluation.…”

Radiofrequency catheter ablation for atrial flutter following orthotopic heart transplantation

“…Radiofrequency ablation procedures following heart transplantation have previously been described 6. Donor hearts with occult bypass tracts have been identified post-transplantation with ablation techniques employed for Wolff-Parkinson-White syndrome 8.…”

“…We describe a patient with recurrent atrial flutter following orthotopic heart transplantation, successfully treated by ablation of the flutter pathway. The successful application of radiofrequency atrial flutter ablation has been reported only once previously following orthotopic heart transplantation 6. Ablation for atrial flutter has been successful in other patients with postoperative atrial scars 7…”

Catheter Ablation of Supraventricular Tachycardia in the Transplanted Heart:

“…While isolated atrial or ventricular ectopy accounts for most of these arrhythmias, sustained arrhythmias are also encountered 1,2 . There have been several case reports of clinically important supraventricular tachycardia (SVT) treated with radiofrequency ablation (RFA) 3–6 . Three cardiac transplant patients, each with a different arrhythmia mechanism, were treated successfully with catheter ablation.…”