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Coexisting normal sinus rhythm and atrial fibrillation 18 years after heart transplant

Raghav Gupta1, Faisal Latif, Tarun W Dasari

  • 1Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. raghav-gupta@ouhsc.edu

Journal of Cardiac Surgery
|November 20, 2008
PubMed

Insights

A heart transplant patient experienced a transient ischemic attack due to two distinct left atrial appendages (LAA) beating independently. One LAA was in normal sinus rhythm, while the other had atrial fibrillation, necessitating anticoagulation therapy.

Area of Science:

  • Cardiology
  • Neurology
  • Transplant Surgery

Background:

  • Atrial fibrillation is a major cause of stroke, making its detection crucial for preventing future events.
  • Anticoagulation therapy is vital for stroke prevention in patients with atrial fibrillation.
  • Standard orthotopic heart transplant (st.OHT) patients require careful monitoring for thromboembolic events.

Observation:

  • A patient with a history of st.OHT presented with a transient ischemic attack (TIA) without prior signs of atrial fibrillation.
  • Transesophageal echocardiography (TEE) and pulse wave (PW) Doppler revealed two distinct left atrial appendages (LAA).
  • The donor LAA exhibited normal sinus rhythm (NSR), while the recipient LAA displayed atrial fibrillation (AF).

Findings:

  • The patient had two coexisting left atrial appendages (LAA) with independent rhythms post-heart transplant.
  • One LAA was in normal sinus rhythm (NSR), and the other was in atrial fibrillation (AF).
  • This rare finding necessitated anticoagulation therapy instead of standard antiplatelet treatment for TIA.

Implications:

  • This case highlights the importance of advanced imaging like TEE in diagnosing rare causes of stroke in heart transplant recipients.
  • Understanding different heart transplant techniques is crucial for recognizing their potential impact on postoperative atrial arrhythmias.
  • Timely diagnosis of dual-rhythm LAA is critical for appropriate anticoagulation and stroke prevention in post-transplant patients.

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