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Cardioversion of atrial fibrillation with ibutilide in an orthotopic heart transplant patient

1999; Elsevier BV; Volume: 18; Issue: 10 Linguagem: Inglês

10.1016/s1053-2498(99)00057-1

1557-3117

Larry Kaufman, Andrea E Kofalvi, Robert Hong, Carlos E. Moreno-Cabral, Lewis L. Low,

Mechanical Circulatory Support Devices

The postoperative complications of heart transplantation are relegated to 4 major categories: rejection, hemodynamics, infection, and rhythm disturbances. Atrial rhythm disturbances are quite frequent with brady- and tachydysrhythmias, presenting with equal regularity (∼50%) in the denervated transplanted heart. 1 Miyamoto Y, Curtiss E, Kormos R, et al. Bradyarrhythmias after heart transplantation. Incidence, time course, and outcome. Circulation 1990 Nov;82(5 suppl):313–7. Google Scholar , 2 Gottfried H. Hirschl M.M. Kratochwill C. et al. Inducible atrial flutter and fibrillation after orthotopic heart transplantation. J Heart Lung Transplant. 1993; 12: 517-521 PubMed Google Scholar , 3 Pavri B.B. O’Nunain S.S. Newell J.B. et al. Prevalence and prognostic significance of atrial arrhythimias after orthotopic cardiac transplantation. J Am Coll Cardiol. 1995; 25: 1673-1680 Abstract Full Text PDF PubMed Scopus (112) Google Scholar These dysrhythmias may or may not be harbingers of rejection. 4 Schmid C. Wahlers T. Schafers H. et al. Supraventricular bradycardia after heart transplantation—orciprenaline or pacemaker implantation?. The Thoracic and Cardiovascular Surgeon. 1993; 41: 101-103 Crossref PubMed Scopus (7) Google Scholar , 5 Jacquet L. Ziady G. Stein K. et al. Cardiac rhythm disturbances early after orthotopic heart transplantation prevalence and clinial importance of the observed abnormalities. J Am Coll Cardiol. 1990; 16: 832-837 Abstract Full Text PDF PubMed Scopus (126) Google Scholar Nonetheless, hemodynamic stability may be jeopardized due to ineffective ventricular filling, thus compromising cardiac output. Because of this denervated state, the efficacy of the “usual” antidysrhythmic agents is altered. Ibutilide, a new class III antiarrhythmic, has been used with success for both atrial fibrillation and flutter of new onset. However, its use has not been described in the transplanted population.