Reversible loss of pre-excitation as a sign of acute cardiac rejection.
A 50-year-old woman presented with signs of mild heart failure 16 months after orthotopic heart transplantation. Cardiac biopsy revealed ISHLT Grade 2R rejection, which was treated with corticosteroids. Electrocardiograms (ECGs) after transplantation showed a pre-excitation pattern; the presenting ECG showed complete loss of pre-excitation, which returned fully within 7 days of steroid therapy. Intermittent pre-excitation had been present for 4 weeks prior to any other clinical sign of rejection. Accessory pathways can display reversible loss of function during acute cellular rejection, and this may precede other clinical signs. This rare but significant finding may have clinical relevance to other transplanted patients with pre-excitation.
Jones
David G
DG
Departments of Cardiology and Transplantation, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Sydney Street, Middlesex, London, UK. davidgarethjones@nhs.net
Bougard
Robert S
RS
Burke
Margaret M
MM
Banner
Nicholas R
NR
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001706:Biopsy; D004562:Electrocardiography; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D016027:Heart Transplantation; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology
D000305:Adrenal Cortex Hormones