Journal Article

Atrial flutter in the recipient atrium induced by premature beats arising from the donor atrium 10 years after orthotopic heart transplantation

Y.-G. Li, B. Bender, G. Grönefeld and S.H. Hohnloser

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 1, issue 4, pages 275-279
Published in print October 1999 | ISSN: 1099-5129
Published online October 1999 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1053/eupc.1999.0058
Atrial flutter in the recipient atrium induced by premature beats arising from the donor atrium 10 years after orthotopic heart transplantation

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Background

Several mechanisms for the genesis of supraventricular arrhythmias in patients after orthotopic heart transplantation have been reported.

Methods and Results

We describe a 58-year-old male patient in whom atrial flutter occurred 10 years after orthotopic heart transplantation. During an electrophysiological study, bidirectional conduction between the recipient and donor atria was found. Atrial flutter in the recipient atrium was induced by programmed stimulation of the donor atrium using a single extrastimulus. The clinical symptoms were caused by atrial flutter arising from the recipient atrium with 1:1 to 3:1 conduction to the donor atrium. Mapping the anastomosis between the two atria indicated fragmented potentials at a discrete site of conduction. Delivery of radiofrequency energy at this site terminated conduction in both directions. Subsequent atrial pacing of the donor and recipient atria, respectively, demonstrated bidirectional conduction block.

Conclusion

Symptomatic arrhythmias in patients after heart transplantation can indirectly originate from the donor atrium via bidirectional recipient–donor atrial conduction. This type of arrhythmia can be successfully treated with radiofrequency ablation.

Keywords: Atrial flutter; heart transplantation; radiofrequency catheter ablation

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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