title: Increased incidence of atrial flutter associated with the rejection of heart transplantation.
abstract: Atrial fibrillation (AF) and atrial flutter (Afl) are common dysrhythmias that occur after orthotopic heart transplantation (OHT); however, their etiology and clinical significance have not been defined. To determine the precise incidence of sustained AF and Afl and their association with cardiac rejection, 892 consecutive patients who underwent OHT were studied. A total of 104 patients had 113 episodes of Afl; 102 patients had 117 episodes of AF. The incidence of Afl (12.7%) was the same as AF (13.1%). Sixty-nine AF episodes occurred in first 2 weeks after transplantation, and 22 of which were associated with rejection. In contrast, only 20 Afl episodes occurred the first 2 weeks after OHT, 10 of which were associated with rejection. Fifty-two episodes of Afl occurred during from the third week to 6 months after transplantation, 34 of which were associated with moderate to severe cellular or humoral rejection and/or transplant coronary artery disease (TCAD). All 41 Afl episodes that occurred 6 months after transplantation were associated with cellular and humoral rejection, and/or TCAD. The prevalence of Afl was significantly higher in biatrial than bicaval anastomosis. Atrial conduction defect, manifested by the increase of terminal force of the P wave in lead V(1) of the surface electrocardiogram, predicted the occurrence of Afl and AF associated with rejection in OHT with a sensitivity of 89% and specificity of 92%. These results demonstrate that the incidence of Afl increased after OHT, which might be a consequence of cellular and humoral rejection, and coronary vasculopathy of the transplanted hearts.
authors.affiliation: Division of Cardiology, Department of Medicine, UCLA Medical Center, UCLA School of Medicine, Los Angeles, California 90095-1679, USA.
authors.forename: G
authors.initials: G
authors.lastname: Cui
authors.forename: T
authors.initials: T
authors.lastname: Tung
authors.forename: J
authors.initials: J
authors.lastname: Kobashigawa
authors.forename: H
authors.initials: H
authors.lastname: Laks
authors.forename: L
authors.initials: L
authors.lastname: Sen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D001282:Atrial Flutter / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D016027:Heart Transplantation / Q000379:methods / Q000502:physiology / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors