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Arrhythmias and sudden cardiac death in post-cardiac transplant patients

Michael A Eskander1, Eric Adler, Kurt S Hoffmayer

  • 1Department of Electrophysiology, Sulpizio Cardiovascular Center, University of California, San Diego Health System, San Diego, California, USA.

Current Opinion in Cardiology
|February 29, 2020
PubMed

Insights

Sudden cardiac death (SCD) remains a significant risk after heart transplantation, linked to cardiac allograft vasculopathy. Identifying risk factors and exploring implantable defibrillators are crucial for improving long-term outcomes.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Cardiac Electrophysiology

Background:

  • Orthotopic heart transplantation (OHT) improves outcomes for end-stage heart disease.
  • Long-term risks of arrhythmias and sudden cardiac death (SCD) persist despite medical advances.

Purpose of the Study:

  • To review risk factors and predictors of arrhythmia and SCD in OHT recipients.
  • To discuss the role of implantable cardiac defibrillators (ICDs) in post-transplant care.

Main Methods:

  • Review of existing literature on SCD and cardiac allograft vasculopathy (CAV) post-OHT.
  • Analysis of risk factors associated with SCD and CAV.

Main Results:

  • SCD accounts for approximately 10% of post-transplant deaths, with a pooled incidence of 1.30 per 100 person-years.
  • SCD is strongly associated with CAV; risk factors include higher donor age, younger recipient age, and reduced ejection fraction.
  • The temporal relationship between CAV and SCD is not well-defined, and the terminal arrhythmia may not always be ventricular fibrillation.

Conclusions:

  • Risk stratification for SCD in OHT patients is essential.
  • Further research is needed to understand the mechanisms linking CAV and SCD.
  • The utility of ICDs in managing arrhythmia risk in OHT recipients warrants consideration.
Abstract

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