Atrial Tachyarrhythmias After Cardiac Transplantation

Cardiac transplant recipients demonstrate a unique substrate for atrial tachyarrhythmias owing to the surgical techniques involved. Surgical modification of the atria during transplant surgery has both proarrhythmic and antiarrhythmic effects detailed in this paper. Cavotricuspid isthmus-dependent right atrial flutter is the most common arrhythmia identified. Atrial fibrillation is uncommon owing to obligatory surgical pulmonary vein isolation. Donor hearts can also contain pre-existing accessory pathways or dual AV nodal physiology causing supraventricular tachycardia for which adenosine treatment is not recommended, but catheter ablation is curable.