Author + information
- Received December 4, 1989
- Revision received March 28, 1990
- Accepted April 13, 1990
- Published online October 1, 1990.
- Luc Jacquet, MD1,
- Galal Ziady, MD, FACC*,1,
- Keith Stein, MD1,
- Bartley Griffith, MD1,
- John Armitage, MD1,
- Robert Hardesty, MD1 and
- Robert Kormos, MD1
- ↵*Address for reprints: Galal Ziady, MD, University of Pittsburgh, 3496 Presbyterian-University Hospital, DeSoto at O’Hara Streets. Pittsburgh, Pennsylvania 15213.
To precisely define the incidence, type and consequences of cardiac arrhythmias early after heart transplantation, 25 cardiac transplant recipients were monitored continuously for 728 days from the day of surgery to discharge or death. A subset of 15 patients had sinus node function studies with overdrive suppression performed weekly at the time of endomyocardial biopsy.
Results revealed sinus bradycardia in 10 patients (40%) and junctional bradycardia in 6 (24%). Supraventricular tachycardia in the form of atrial tachycardia, atrial fibrillation and atrial flutter occurred in 11 patients (44%). Ventricular tachycardia occurred in 15 patients (60%) and was nonsustained in all. Cardiac pacing for 1,403 h was used in nine patients with a pulse rate <50 beats/min; seven recovered and permanent pacing was instituted in two. In the subgroup that had sinus node function studies, seven patients were identified with clinical bradyarrhythmia; each had abnormal sinus node recovery time (> 1,400 ms) and abnormal corrected sinus node recovery time (>525 ms) in at least one study. These seven patients also had a significantly prolonged ischemic time (236 ± 26 versus 159 ± 68 min, p < 0.01).
In conclusion, cardiac arrhythmias, particularly ventricular tachycardia and bradyarrhythmia, occur more commonly early after orthotopic heart transplantation than has previously been reported. Sinus node dysfunction due to prolonged organ ischemic time, antiarrhythmic drug use or surgical trauma, alone or in combination, may contribute to these arrhythmias.
- Received December 4, 1989.
- Revision received March 28, 1990.
- Accepted April 13, 1990.
- American College of Cardiology Foundation