© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
One heart, two minds
University of Ottawa Heart Institute 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
Manuscript submitted 29 September 2004. Accepted after revision 20 June 2005.
*Corresponding author. Queen Elizabeth Hospital, Cardiology, Edgbaston, Birmingham, West Midlands B15 2TH, United Kingdom. Tel.: +44 121 472 1311. E-mail address: ernest.lau{at}btinternet.com
 |
Abstract |
|---|
 Top Abstract Reference |
|---|
A case of complex atrial tachyarrhythmias following orthotopic heart transplantation is presented. The ablation strategy in such a situation and the outcome achieved are discussed.
Key Words: cardiac transplantation, atrial flutter, atrial tachycardia, ablation, suture line
Conduction of the native sinus rhythm across the suture line to the donor heart occurs in up to 10% of patients following orthotopic cardiac transplantation. Conduction of atrial arrhythmias occurs less frequently. We describe a complex case of atrial tachyarrhythmias involving the interaction between the native right atrium (NRA) and donor right atrium (DRA) across the suture line.
A 23-year-old man underwent cardiac transplantation at the age of 17 after viral myocarditis. Five years after transplantation, he developed two morphologically distinct forms of atrial flutter/tachycardia. At electrophysiological study, the NRA was in atrial tachycardia with a cycle length of 245 ms and dissociated from the DRA, which was in typical counter-clockwise atrial flutter with a cycle length of 300 ms, as judged by the activation sequence recorded on a halo catheter positioned around the tricuspid annulus of the donor heart and entrainment from the cavo-tricuspid isthmus (Fig. 1(a)). After successful cavo-tricuspid isthmus ablation (Fig. 2), the atrial tachycardia in the NRA began conducting 2:1 to the DRA and ventricles (Fig. 1(b)). Activation covered less than 50% of the tachycardia cycle length in the NRA, and ablation of the earliest site in the antero-superior region of the NRA terminated the tachycardia (Fig. 2). Afterwards, the rhythm alternated between sinus rhythm from the DRA capturing both the NRA and ventricles (Fig. 1(c)) and sinus rhythm from the NRA capturing both the DRA and ventricles (Fig. 1(d)). To prevent any recurrent atrial tachycardia in the NRA being conducted to the donor heart, after verifying that the donor sinus node was chronotropically competent, the conduction point between the NRA and DRA was also ablated (Fig. 2). Afterwards, the patient remained in sinus rhythm from the DRA with dissociated P waves from the NRA, also visible on the electrocardiogram. This case illustrates the exhaustive ablation strategy that may have to be employed in such a case.
|
|
|
Footnotes |
|---|
1Tel.: +1 613 761 4914; fax: +1 613 761 4407. dbirnie{at}ottawaheart.ca
|
Reference |
|---|
|
TopAbstractReference |
|---|
[1] Aziz T.M., Burgess M.I., El Gamel A., Campbell C.S., Rahman A.N., Deiraniya A.K., et al. Orthotopic cardiac transplantation technique: a survey of current practice. Ann Thorac Surg 1999; 68: 1242–1246.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||