Recipient-to-donor atrioatrial conduction after orthotopic heart transplantation: surface electrocardiographic features and estimated prevalence.
Recipient-to-donor atrioatrial conduction across a suture line has been rarely reported after orthotopic heart transplantation. The relation of such conduction to symptomatic arrhythmias and its prevalence are not known. Recipient-to-donor atrioatrial conduction was demonstrated in a 28-year-old woman with paroxysmal supraventricular tachycardia 7 years after orthotopic heart transplantation. Atrial tachycardia in the recipient atria conducted 2:1 to the donor atria and was eliminated by radiofrequency catheter ablation of a left-sided atrioatrial electrical connection. The electrocardiogram at rest and during exercise, recorded before ablation of the recipient-to-donor connection, showed frequent atrial premature complexes, with variable coupling to the preceding sinus beats, and a change in P-wave morphology during exercise, which reverted to normal during the recovery period. These findings were eliminated by ablation of the recipient-to-donor connection. To determine the prevalence of recipient-to-donor atrioatrial conduction late after transplantation, we evaluated the exercise electrocardiograms of 50 subjects > 5 years after heart transplantation for these features of recipient-to-donor conduction. At least 1 feature was present in 5 subjects, and both were present in 1 subject. Electrical conduction can occur across surgical suture lines in the atria. Recipient-to-donor atrioatrial conduction may occur in < or = 10% of patients late after heart transplantation. It is a potential cause of arrhythmias that can be effectively treated with radiofrequency catheter ablation.
Lefroy
D C
DC
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Fang
J C
JC
Stevenson
L W
LW
Hartley
L H
LH
Friedman
P L
PL
Stevenson
W G
WG
D000328:Adult; D000368:Aged; D016275:Atrial Function; D015986:Confounding Factors, Epidemiologic; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012146:Rest