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Recipient-to-donor atrioatrial conduction after orthotopic heart transplantation: surface electrocardiographic
D C Lefroy1, J C Fang, L W Stevenson
1Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Insights
Recipient-to-donor atrioatrial conduction, a rare finding after heart transplantation, can cause arrhythmias. Radiofrequency catheter ablation effectively treats this electrical connection, improving patient outcomes.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Transplantation Medicine
Background:
- Orthotopic heart transplantation involves surgical anastomosis of recipient and donor atria.
- Electrical conduction across the atrial suture line is a rare but documented phenomenon.
Observation:
- A patient with paroxysmal supraventricular tachycardia 7 years post-transplant exhibited recipient-to-donor atrioatrial conduction.
- Atrial tachycardia in the recipient atrium conducted to the donor atrium, causing arrhythmias.
Findings:
- Radiofrequency catheter ablation of a left-sided atrioatrial electrical connection eliminated the patient's arrhythmias.
- Exercise electrocardiogram analysis of 50 heart transplant recipients revealed recipient-to-donor conduction features in 10% of patients.
Implications:
- Recipient-to-donor atrioatrial conduction is a potential cause of arrhythmias late after heart transplantation.
- This conduction can be effectively treated with radiofrequency catheter ablation, offering a therapeutic option for affected patients.
Abstract:
Recipient-to-donor atrioatrial conduction across a suture line has been rarely reported after orthotopic heart transplantation. The relation of such conduction to symptomatic arrhythmias and its prevalence are not known. Recipient-to-donor atrioatrial conduction was demonstrated in a 28-year-old woman with paroxysmal supraventricular tachycardia 7 years after orthotopic heart transplantation. Atrial tachycardia in the recipient atria conducted 2:1 to the donor atria and was eliminated by radiofrequency catheter ablation of a left-sided atrioatrial electrical connection. The electrocardiogram at rest and during exercise, recorded before ablation of the recipient-to-donor connection, showed frequent atrial premature complexes, with variable coupling to the preceding sinus beats, and a change in P-wave morphology during exercise, which reverted to normal during the recovery period. These findings were eliminated by ablation of the recipient-to-donor connection. To determine the prevalence of recipient-to-donor atrioatrial conduction late after transplantation, we evaluated the exercise electrocardiograms of 50 subjects > 5 years after heart transplantation for these features of recipient-to-donor conduction. At least 1 feature was present in 5 subjects, and both were present in 1 subject. Electrical conduction can occur across surgical suture lines in the atria. Recipient-to-donor atrioatrial conduction may occur in < or = 10% of patients late after heart transplantation. It is a potential cause of arrhythmias that can be effectively treated with radiofrequency catheter ablation.
