Supraventricular Tachycardia After Orthotopic Cardiac Transplantation

Vaseghi, Marmar; Boyle, Noel G.; Kedia, Rohit; Patel, Jignesh; Cesario, David A.; Wiener, Isaac; Kobashigawa, Jon A.; Shivkumar, Kalyanam

doi:10.1016/j.jacc.2008.02.065

Cited by 116 publications

(155 citation statements)

References 34 publications

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“…1,2 After cardiac transplantation, atrial fibrillation (AF) or atrial flutter (AFL) are frequent in the immediate postoperative period and are associated with acute rejection or transplant vasculopathy, but macroreentrant or focal atrial tachycardia (AT) are observed later after cardiac transplantation. 3 AT and AFL observed after atrial surgery are often related to surgical lines of conduction block and regions of slow conduction. [3][4][5] AT in the recipient atria conducting to the donor atria has also been described after cardiac transplantation.…”

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confidence: 99%

Atrial Arrhythmias After Lung Transplantation

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Roberts‐Thomson

Stevenson

et al. 2009

Circ: Arrhythmia and Electrophysiology

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Background-Atrial arrhythmias (AAs) including atrial fibrillation (AF) and atrial tachycardia (AT) are often observed after cardiothoracic surgery. Our aim was to evaluate the prevalence and mechanism of AAs after lung transplantation. Methods and Results-All patients (nϭ127) after bilateral sequential lung transplantation followed at our institution over 20 years were included. All patients received postoperative rhythm monitoring and clinic visits with ECG at 1, 3, 6, and 12 months, or as needed. AAs occurred in 40 of 127 (31.5%) patients over 4.2Ϯ4.1 years. AA prevalence at postoperation and 1, 3, 6, 12, and Ͼ12 months was 24%, 11%, 3%, 2%, 4%, and 11%, respectively. Early AAs were predominantly AF, whereas all AAs Ͼ12 months were AT. Time to first AF versus AT was 11Ϯ9 versus 1485Ϯ2462 days (Pϭ0.09). Male sex, age, and preoperative AA predicted any early (Ͻ3 months) AA but did not predict late AA. Early AA did not predict late AT. In 4 patients with drug-resistant AT, electrophysiology studies found AT involving the pulmonary vein/left atrium anastomoses in 3 patients, including donor-to-recipient conduction in 1, border zone macroreentry in 2, and cavotricuspid isthmus dependent flutter in 1; all patients were successfully treated with ablation. Conclusions-AAs after lung transplantation are common. Although AF is common early, AF is rare after healing of left atrial incisions, which probably result in surgical pulmonary vein isolation with rare exception. This raises the question of whether additional surgical or ablation lines at the time of lung transplantation would prevent late AA. (Circ Arrhythmia Electrophysiol. 2009;2:504-510.)

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confidence: 99%

Atrial Arrhythmias After Lung Transplantation

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Roberts‐Thomson

Stevenson

et al. 2009

Circ: Arrhythmia and Electrophysiology

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“…In general, focal AT originating from the donor RA has rarely been observed, except for in cases with an atrial insult such as rejection or ischemia. 1,13) This case, however, had normal contraction and no signs of rejection including any cell-mediated immunity or humoral immunity, vasculopathy judged by coronary angiography and an intravascular ultrasound analysis, or infection.…”

Section: Discussionmentioning

confidence: 86%

“…1) Their frequency was reported to be 12% to 17% of all orthotopic heart transplantation patients studied and 2.3% in the pediatric orthotopic heart transplantation population. [2][3][4] Most of previously reported supraventricular tachycardias had a reentry mechanism involving substrates such as scars and pre-existing accessory pathways, or a dual atrioventricular nodal physiology in donor hearts.…”

Section: Discussionmentioning

confidence: 96%

Catheter Ablation of Focal Atrial Tachycardia Originating From a Donor Heart After Bicaval Orthotopic Heart Transplantation Guided by a Noncontact Mapping System

et al. 2012

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SummaryA 19-year-old man who underwent bicaval orthotopic heart transplantation for idiopathic dilated cardiomyopathy complained of palpitations 2 weeks after the heart transplantation. An ECG revealed paroxysmal atrial tachycardia (AT) with a cycle length of 260 ms and the P wave morphology of the AT was similar to that during sinus rhythm. Echocardiography showed normal contraction. No rejection, vasculopathy, or infection was observed. An electrophysiologic study and catheter ablation guided by a noncontact mapping system were performed due to drug refractory AT. The AT was induced spontaneously by isoproterenol infusion. The activation sequence of the AT exhibited a focal pattern, and the breakout site of the AT into the donor right atrium was just 12 mm below the breakout site of the donor sinoatrial node. Radiofrequency catheter ablation eliminated this AT and resulted in an improvement in the symptoms. (Int Heart J 2012; 53: 146-148) Key words: Atrial tachycardia, Bicaval orthotopic heart transplantation, Catheter ablation, Noncontact mapping system O rthotopic heart transplantation is an established and effective therapy for end-stage heart disease. The bicaval anastomosis method better preserves normal right atrial anatomy and function, may minimize any sinoatrial (SA) node trauma, and minimizes the tachyarrhythmia events. However, we present here an interesting case in which paroxysmal focal AT originating from the donor RA was observed without any rejection, vasculopathy, or infection during the subacute phase after bicaval orthotopic heart transplantation and was successfully ablated guided by a noncontact mapping system. Case ReportA 19-year-old man underwent a bicaval orthotopic heart transplant for idiopathic dilated cardiomyopathy. He had received immunosuppressant drugs and steroid therapy. He began complaining of palpitations 2 weeks after the transplant. An ECG revealed paroxysmal atrial tachycardia (AT) ( Figure 1). The AT exhibited a sudden onset with physical activity and sudden termination. The morphology of the AT exhibited positive P waves in leads II, III, and aVF and was biphasic in lead V1. Echocardiography revealed normal contractions and there were no signs of rejection, vasculopathy, or infection. An electrophysiologic study and catheter ablation were performed due to AT refractory to drugs such as bisoprolol and verapamil. The AT was not induced by programming stimulation, however, an AT with a cycle length of 260 ms was spontaneously induced during isoproterenol infusion and was consistent with the clinical AT. The P wave of the AT was similar to that during sinus rhythm and overdrive atrial pacing and infusion of adenosine transiently suppressed the tachycardia (Figure 2). An Ensite Array was inserted into the right atrium (RA) and its geometry was created. The AT terminated while creating the RA geometry, however, the virtual activation sequence of the AT was recorded by the noncontact mapping system. The acti- vation sequence of the AT exhibited a focal pattern and the b...

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“…Previous studies demonstrated that about a quarter of these patients developed SVT attributed to macro-reentrant tachycardia, and about 4% underwent EP studies [2,3]. Anesthesia for ablation procedures in these patients mandate several considerations including transplant technique used, interventional cardiology procedure performed, and particular complications common to post transplant patients.…”

Section: Discussionmentioning

confidence: 99%

“…As a result of an increasing number of patients surviving cardiac transplantation and the relatively high incidence of atrial arrhythmias in these patients, ablation procedures under anaesthesia may be required [2,3]. Percutaneous catheter ablation is done with applying electrical triggers around the pulmonary vein ostia in order to accomplish pulmonary vein isolation using radiofrequency current.…”

Section: Introductionmentioning

confidence: 99%

Anaesthesia Management for Ablation Therapy in Post Heart Transplant Arrhythmia

Prapaitrakool¹,

Bainbridge²,

Lavi³

2013

OJAnes

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In this case series we describe the anaesthetic management of atrial ablation for arrhythmia in three post heart transplant patients. These patients provide a unique challenge to the anaesthesiologist, as heart physiology, end organs effects, procedural related factors should all be part of the specific anaesthetic plan tailored for each patient individually. The different anaesthetic techniques applied, and procedure related complications are evaluated. Anaesthetic management, procedural related difficulties, pharmacologic aspects, and possible associated complications are reviewed.

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Supraventricular Tachycardia After Orthotopic Cardiac Transplantation

Cited by 116 publications

References 34 publications

Atrial Arrhythmias After Lung Transplantation

Atrial Arrhythmias After Lung Transplantation

Catheter Ablation of Focal Atrial Tachycardia Originating From a Donor Heart After Bicaval Orthotopic Heart Transplantation Guided by a Noncontact Mapping System

Anaesthesia Management for Ablation Therapy in Post Heart Transplant Arrhythmia

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