Recipient-to-donor atrioatrial conduction after orthotopic heart transplantation: surface electrocardiographic features and estimated prevalence

• Published in: The American journal of cardiology 1998-08, Vol.82 (4), p.444-450
• Main Authors: Lefroy, David C., Fang, James C., Stevenson, Lynne W., Hartley, L.Howard, Friedman, Peter L., Stevenson, William G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Atrial Function; Biological and medical sciences; Cardiac arrhythmia; Cardiology; Confounding Factors (Epidemiology); Electrocardiography; Exercise Test; Female; Heart Conduction System - physiopathology; Heart Transplantation; Humans; Male; Medical sciences; Middle Aged; Prevalence; Rest; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Transplants & implants
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00359-2

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 ≤10% of patients late after heart transplantation. It is a potential cause of arrhythmias that can be effectively treated with radiofrequency catheter ablation.