title: [Atrial flutter: a possible early sign of acute rejection in heart transplantation. A case report].
abstract: 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.
authors.affiliation: RETAC, Réseau européen pour le traitement des arythmies cardiaques, service de cardiologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges.
authors.forename: S
authors.initials: S
authors.lastname: Boveda
authors.forename: M
authors.initials: M
authors.lastname: Galinier
authors.forename: P
authors.initials: P
authors.lastname: Lagrange
authors.forename: A
authors.initials: A
authors.lastname: Lagrange
authors.forename: A
authors.initials: A
authors.lastname: Cérène
authors.forename: M
authors.initials: M
authors.lastname: Delay
authors.forename: H
authors.initials: H
authors.lastname: Baccar
authors.forename: P
authors.initials: P
authors.lastname: Defaye
authors.forename: J P
authors.initials: JP
authors.lastname: Bounhoure
authors.forename: J M
authors.initials: JM
authors.lastname: Fauvel
mesh_terms: 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