title: Mode and mechanisms of death after orthotopic heart transplantation.
abstract: BACKGROUND
  Ventricular fibrillation (VF) is the primary mechanism of cardiac arrest in the vast majority of sudden death patients. Whether similar modes and mechanisms of death can be generalized to denervated hearts in orthotopic heart transplantation (OHT) patients is unknown.
  
  
  OBJECTIVE
  The purpose of this study was to determine the mode and mechanisms of death in patients who have undergone cardiac transplantation.
  
  
  METHODS
  We analyzed the outcomes of 628 patients who underwent OHT between January 1994 and December 2004. The mode of death was classified as either sudden death (SD) or non-sudden death (NSD). The first documented rhythm taken at the time of arrest was also reviewed to determine the mechanism of cardiac arrest.
  
  
  RESULTS
  During a mean follow-up of 76 months, 194 patients died. Of these, the mode of death could be determined in 116 patients (60%). Forty-one patients (35%) died of SD, and 75 patients (65%) died of NSD. The first documented rhythm of death was available in 91 patients (26 SD and 65 NSD). The terminal rhythms in patients who died suddenly were: asystole (34%), pulseless electrical activity (PEA) (20%), and VF (10%). In NSD patients, the terminal rhythms were asystole (73%), followed by VF (7%), and PEA (7%), P < .001 compared with SD patients.
  
  
  CONCLUSIONS
  SD represented the mode of death in 35% of OHT patients. The main mechanisms underlying SD in this population were asystole and PEA, suggesting that denervation of the donor heart, among other post-transplantation changes, may alter susceptibility to VF.
authors.affiliation: UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA.
authors.forename: Marmar
authors.initials: M
authors.lastname: Vaseghi
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lellouche
authors.forename: Harry
authors.initials: H
authors.lastname: Ritter
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Jignesh K
authors.initials: JK
authors.lastname: Patel
authors.forename: Jaime
authors.initials: J
authors.lastname: Moriguchi
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fishbein
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar