Supraventricular tachycardia after orthotopic cardiac transplantation.
OBJECTIVE
The purpose of this study was to define the incidence, mechanisms, and management, including catheter ablation, of supraventricular tachycardia (SVT) in a large series of patients after orthotopic heart transplantation (OHT).


BACKGROUND
Supraventricular arrhythmias are frequently encountered after OHT, but their characteristics in this population have not been well established.


METHODS
We analyzed the incidence, clinical course, and management of SVTs in a cohort of 729 adult patients who underwent OHT. Furthermore, the mechanisms of arrhythmias among the patients referred for electrophysiological study (EPS) and ablation were also characterized.


RESULTS
The most common arrhythmia was atrial flutter, which occurred in 9% of this cohort. Persistent or paroxysmal atrial fibrillation occurred in 7%, the majority (57%) in the perioperative period. Persistent or paroxysmal atrial fibrillation was observed in OHT patients, beyond the post-operative period, only in the presence of rejection or transplant vasculopathy. Other persistent or paroxysmal SVTs were seen in 47 stable OHT patients (7%). Of these, 24 patients (4%) underwent EPS. Accessory and dual atrioventricular nodal pathways in the donor heart caused SVT in 3 patients. Macro-reentrant atrial tachycardia was seen in 7 patients, and isthmus-dependent atrial flutter occurred in 14 patients.


CONCLUSIONS
The majority of SVTs in stable OHT patients can be attributed to macro-reentrant tachycardias (flutter and scar reentry). Catheter ablation is effective in management of these SVTs. Atrial fibrillation was never encountered in stable patients in our series, and its occurrence should prompt an evaluation for acute rejection and/or vasculopathy.
UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA.
Marmar
M
Vaseghi
Noel G
NG
Boyle
Rohit
R
Kedia
Jignesh K
JK
Patel
David A
DA
Cesario
Isaac
I
Wiener
Jon A
JA
Kobashigawa
Kalyanam
K
Shivkumar
D001281:Atrial Fibrillation / Q000209:etiology; D017115:Catheter Ablation; D005260:Female; D006339:Heart Rate; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors