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Atrial Reentrant Tachycardia After Heart Transplantation

1999; Lippincott Williams & Wilkins; Volume: 99; Issue: 2 Linguagem: Inglês

10.1161/01.cir.99.2.326

1524-4539

Ellen Hoffmann, Christopher Reithmann, P. Nimmermann, T. Remp, Gerhard Steinbeck,

Cardiac pacing and defibrillation studies

HomeCirculationVol. 99, No. 2Atrial Reentrant Tachycardia After Heart Transplantation Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBAtrial Reentrant Tachycardia After Heart Transplantation Ellen Hoffmann, Christopher Reithmann, Petra Nimmermann, Thomas Remp and Gerhard Steinbeck Ellen HoffmannEllen Hoffmann From Medical Hospital I, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany. , Christopher ReithmannChristopher Reithmann From Medical Hospital I, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany. , Petra NimmermannPetra Nimmermann From Medical Hospital I, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany. , Thomas RempThomas Remp From Medical Hospital I, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany. and Gerhard SteinbeckGerhard Steinbeck From Medical Hospital I, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany. Originally published19 Jan 1999https://doi.org/10.1161/01.CIR.99.2.326Circulation. 1999;99:326–327A68-year-old man presented with an incessant supraventricular tachycardia 3 months after heart transplantation. A dual-chamber pacemaker had been implanted immediately after surgery for bradyarrhythmias. Electrophysiological study was performed with a multipolar halo catheter (20 electrode pairs) in the right atrium and bi- or quadripolar catheters in a high lateral, His, and coronary sinus ostium position of the right atrium (Figure, top right). An atrial reentrant tachycardia was depicted in the transplanted atrium from the proximal recordings of the halo (electrodes 17, 18 to 9, 10), while simultaneously, sinus rhythm of the remaining right atrium of the recipient heart could be recorded from the distal halo electrodes (5, 6 to 1, 2), with both rhythms overlapping at electrodes 7, 8 (Figure, top left).The CARTO mapping system provides a three-dimensional electroanatomic reconstruction of the heart chamber and a color-coded representation of the endocardial activation sequence. We mapped 15 points of the "old" atrium during sinus rhythm, giving the typical picture of a "focal" atrial activation sequence of the sinus node (Figure, bottom left). Of the "new" transplanted atrium, 111 positions were mapped during the ongoing atrial tachycardia, visualizing the typical signs of a macroreentrant tachycardia with adjacent sites of the earliest (red) and latest (violet) local activation (Figure, bottom right).Curative radiofrequency catheter ablation of the reentrant tachycardia was primarily successful. However, atrial tachyarrhythmias recurred 3 months after the ablation. Because signs of tachycardiomyopathy developed, we decided to perform His bundle ablation as a definitive treatment. Six months later, the patient has normal heart function and is free of tachyarrhythmia recurrences.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.Download figureDownload PowerPointFootnotesCorrespondence to Ellen Hoffmann, MD, Klinikum Grosshadern, Ludwig-Maximilians-University, 81366 Munich, Germany. Previous Back to top Next FiguresReferencesRelatedDetailsCited By LI Y, Grönefeld G, Israel C, LU S, WANG Q and Hohnloser S (2006) Radiofrequency catheter ablation in patients with symptomatic atrial flutter/tachycardia after orthotopic heart transplantation, Chinese Medical Journal, 10.1097/00029330-200612020-00003, 119:24, (2036-2041), Online publication date: 1-Dec-2006. Kantharia B, Wilbur S, Kutalek S and Padder F (2005) Electroanatomical Mapping and Radiofrequency Catheter Ablation of Atrial Tachycardia Originating from the Recipient Heart with Recipient-to-Donor Atrio-Atrial Conduction After Orthotopic Heart Transplantation, Journal of Interventional Cardiac Electrophysiology, 10.1007/s10840-005-5842-1, 12:1, (61-67), Online publication date: 1-Jan-2005. MAGNANO A and GARAN H (2003) Catheter Ablation of Supraventricular Tachycardia in the Transplanted Heart:, Pacing and Clinical Electrophysiology, 10.1046/j.1460-9592.2003.00284.x, 26:9, (1878-1886), Online publication date: 1-Sep-2003. Dugas M, Hoffmann E, Janko S, Hahnewald S, Matis T, Miller J, Bary C, Farnbacher A, Vogler V and Überla K (2002) Complexity of biomedical data models in cardiology: the Intranet-based AF registry, Computer Methods and Programs in Biomedicine, 10.1016/S0169-2607(01)00162-6, 68:1, (49-61), Online publication date: 1-Apr-2002. STROHMER B, CHEN P and HWANG C (2000) Radiofrequency Ablation of Focal Atrial Tachycardia and Atrioatrial Conduction from Recipient to Donor after Orthotopic Heart Transplantation, Journal of Cardiovascular Electrophysiology, 10.1111/j.1540-8167.2000.tb01764.x, 11:10, (1165-1170), Online publication date: 1-Oct-2000. Horrocks I, Sattler U, Tessaris S and Tobies S How to Decide Query Containment under Constraints Using a Description Logic Logic for Programming and Automated Reasoning, 10.1007/3-540-44404-1_21, (326-343) COMPTON S and STROBEL G (1999) Sesquiflutter, Journal of Cardiovascular Electrophysiology, 10.1111/j.1540-8167.1999.tb00215.x, 10:11, (1557-1558), Online publication date: 1-Nov-1999. January 19, 1999Vol 99, Issue 2 Advertisement Article InformationMetrics Copyright © 1999 by American Heart Associationhttps://doi.org/10.1161/01.CIR.99.2.326 Originally publishedJanuary 19, 1999 PDF download Advertisement