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Late atrioventricular block after heart transplantation
Yen-Wen Wu1, Wen-Jone Chen, Nai-Kuan Chou
1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Journal of the Formosan Medical Association = Taiwan Yi Zhi
|April 24, 2003
Summary
Permanent pacing is common after heart transplants due to bradyarrhythmia. This case highlights a rare instance of late-onset atrioventricular block, emphasizing the need for ongoing cardiac monitoring post-transplant.
Area of Science:
- Cardiology
- Transplant Medicine
- Electrophysiology
Background:
- Bradyarrhythmia necessitating permanent pacing is a frequent complication following heart transplantation.
- Sinus node dysfunction is the primary reason for pacemaker implantation in these patients.
- Late-onset atrioventricular (AV) block is an infrequently observed complication.
Observation:
- A heart transplant recipient developed advanced AV block 41 months post-transplantation.
- Serial electrocardiograms revealed right bundle branch block with progressive QRS duration increase.
- The patient had no signs of acute rejection or coronary artery disease at the time of AV block onset.
Findings:
- The case presents a rare occurrence of late-onset high-grade atrioventricular block.
- Progressive conduction system disease is a potential, though unclear, mechanism for this late complication.
- Absence of rejection and normal coronary angiography suggests non-ischemic and non-rejection etiologies.
Implications:
- This case underscores the possibility of delayed conduction abnormalities after heart transplantation.
- It suggests the need for long-term electrocardiographic surveillance in heart transplant recipients.
- Further research into the mechanisms of late AV block is warranted to optimize patient management.