Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with orthotopic heart transplantation by bicaval anastomosis

Abstract

Patients with orthotopic heart transplantation may have a variety of arrhythmias. There are reports of successful radiofrequency catheter ablation of some of them. Two months after orthotopic cardiac transplantation by bicaval anastomosis, a 49-year-old man developed episodes of tachycardia. The patient developed with dyspnoea and hypotension during typical atrioventricular nodal reentrant tachycardia (AVNRT) revealed by electrocardiogram. During programmed atrial stimulation with progressively increasing prematurity, dual auriculoventricular nodal physiology was observed and AVNRT was induced. This tachycardia was successfully eliminated without complications by radiofrequency catheter ablation of the slow pathway. The patient remained asymptomatic at 4-month follow-up.

Supraventricular Tachycardia After Orthotopic Cardiac Transplantation

“…Furthermore, although more than one-half of the reported cases required ablation within 1 month, RFA was curative in all cases. Cases of AVNRT reported in post-OHT patients are rare (1,2,5). Once again, RFA with slow pathway modification was effective at treating AVNRT in all cases.…”

“…Transplanted hearts provide a unique model to study the management of these arrhythmias, because of the relative autonomic denervation and the pro-arrhythmic characteristics of surgical scars. Previous studies have reported atrioventricular nodal (AVNRT) and atrioventricular reentrant tachycardias (AVRT) in transplanted patients due to pre-existing accessory pathways and dual atrioventricular nodal physiology in the donor hearts (1)(2)(3)(4)(5). Macroreentrant atrial tachycardias (ATs) from pro-arrhythmic substrates originating at surgical anastomotic sites have also been reported (6 -9).…”

Radiofrequency ablation of atrioventricular nodal reentrant tachycardia in an orthotopic heart transplantation patient

“…As a result, the true etiologies of many of these tachyarrhythmias are not identified, and the reported incidences of symptomatic AVNRT in OHT patients are limited. In spite of anatomic and autonomic differences compared with non‐OHT patients, RF catheter ablation has been reported to yield successful elimination of AVNRT in OHT patients . Our patient has been free of any cardiac symptoms since the ablation, and a second biopsy continues to be negative for rejection.…”

“…In our case, the donor heart developed AVNRT after 3 months without any evidence of rejection on the endomyocardial biopsy. Few case reports have documented this phenomenon . Transplanted hearts undergo major surgical distortion of cardiac anatomy subsequently leading to surgical scars, which are known to be arrhythmogenic .…”

“…Rarely, the paroxysmal supraventricular arrhythmias (PSVTs), such as atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reciprocating tachycardia (AVRT), and Wolff Parkinson‐White in transplant recipients, have been reported and are not associated with rejection . There are no absolute correlations between these arrhythmias and heart transplant.…”