[Atrial flutter: a possible early sign of acute rejection in heart transplantation. A case report].
The authors report the case of a cardiac transplant patient with a recurrence of atrial flutter two months after electrical cardioversion and despite long-term preventive treatment with amiodarone. Early investigation for signs of rejection with 4 endomyocardial biopsies was negative. Aggravation of the haemodynamic status due to flutter with a rapid ventricular response led to an attempted radio-frequency ablation. Endocavitary mapping confirmed persistence of sinus activity in the native atrium and the presence of a circuit of type I isthmic flutter (anticlockwise circuit) in the donor atrium. Ablation by radio-frequency in the same procedure was successful. A fifth myocardial biopsy the same day finally confirmed stage 3A acute rejection. No signs of recurrent rejection or arrhythmia have been observed after 24 months' follow-up in this patient. This preliminary experience confirms the need to look for graft rejection by repeated myocardial biopsies in cardiac transplant, patients with atrial flutter and the efficacy of radio-frequency ablation in cases of resistance to conventional therapy.
Boveda
S
S
RETAC, Réseau européen pour le traitement des arythmies cardiaques, service de cardiologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges.
Galinier
M
M
Lagrange
P
P
Lagrange
A
A
Cérène
A
A
Delay
M
M
Baccar
H
H
Defaye
P
P
Bounhoure
J P
JP
Fauvel
J M
JM
D001282:Atrial Flutter / Q000209:etiology*; D001706:Biopsy; D017115:Catheter Ablation; D004554:Electric Countershock; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D012008:Recurrence