Atrial conduction disturbance as an indicator of rejection after cardiac transplantation

Abnormalities of the terminal force of the P wave in Lead V1 (ptf-V1) and dispersion of corrected atrial repolarization (Ta-TcD) are believed to represent interatrial conduction defect.

To determine whether atrial conduction disturbance correlates with cardiac allograft rejection, we analyzed 249 twelve-lead-electrocardiograms, echocardiograms, hemodynamic parameters, and endomyocardial biopsys from 137 patients with heart transplantation. Both ptf-V1 and Ta-TcD were significantly increased in patients with severe, moderate, and mild rejection. In 22 patients, significant increases of the ptf-V1 and Ta-TcD were observed before positive histological findings, and significantly correlated with severity of rejection during 5- week to 1-year follow-up. Increase of 0.030 mm x sec in ptf-V1 or 0.040 s1/2 in Ta-TcD indicated cardiac rejection > or =1B with sensitivity of 88 and 83%, specificity of 85 and 77%, respectively.

These results suggest that the ptf-V1 and Ta-TcD might be an adjunct to detect rejection and reduce the number of surveillance EMB.