Logo Annals of Transplantation Logo Annals of Transplantation Logo Annals of Transplantation

06 December 2003

Atrial resynchronization in patients after heart transplantation.

Andrzej Kutarski, Michał M Zakliczyński, Krzysztof K Oleszczak, Jacek J Kuśnierz, Bogdan B Lech, Jacek J Wojarski, Zbigniew Z Kalarus, Roman R Przybylski, Teresa T Widomska-Czekajska, Zbigniew Z Religa, Marian M Zembala

Ann Transplant 2002; 7(2): 11-17 :: ID: 5554

Abstract

Lower-Shumway technique (atrioatrial anastomosis) is the most frequently used technique for orthotopic heart transplantation and such a patient has two right atria and two sinus nodes. Sinus node dysfunction (SND) is a frequent finding in pts. after OHT; taking advantage of the frequency of innervated sinus node of recipient's atrial remnant as a natural biosensor for triggered pacing of donor atrium is an interesting option for these pts. THE AIMS OF OUR STUDY: 1. the analysis of possibility of utility of recipient atrial sinus node as natural biosensor for triggered donor atrium permanent pacing in transplanted patients with SND. 2. the evaluation of pacing and sensing conditions of the recipient's atrium in the some pts.. 3. long-term observation of effectiveness A2A2T(/D) pacing mode. METHODS: 10 out of 37 pts. received A2A2T (8 pts.) and A2A2T/D (2 pts) pacing systems. In pts. with NSR of recipients atrium, we evaluated acceleration of its frequency during slight exercise and atropine. RESULTS: In recipient's atrium among 37 pts we recognized NSR only in 15/37 pts.; in the remaining 22 pts. we found: sinus bradycardia--in 3, atrial flutter--in 3, low voltage AF--in 12 and no electrical activity--in 4 pts. Positive response to isometric exercise and atropine was observed in 12/15 pts. and 8 of them received A2A2T or A2A2T/D pacing system. We found much better sensing and pacing conditions in donor (A wave 2.1 mV, p. threshold 0.8 V) than in recipient atrium (1.1 mV and 1.4 V respectively). We observed some problems with sensing of recipient atrium in 4 of 10 pts. and changes SST to AAI-R mode solved the problem without loss of atrial resynchronization. 9 out of 10 pts. preferred AAT to AAI-R pacing program. One dislodged lead required revision during postoperative period (1/44, 2%). There was no dislodgement related to endomyocardial biopsy. In one patient, atrial flutter in recipient atria was transmitted to atrium of transplanted heart by pacing system with 2:1 conduction; arrhythmia was interrupted with drugs and did not return. CONCLUSIONS: 1. Atrial resynchronization is possible only in about 1/4 patients with SND after OHT due to frequently noted electrophysiological changes in recipient atrium. 2. In transplanted heart patients sensing and pacing conditions are much more favorable in donor's than recipient's atrium. 3. Atrial resynchronization can be subjectively (positively) recognised by most of patient after OHT and it still remains a promising pacing mode for selected patients after OHT with SND.

Keywords: Arrhythmias, Cardiac - surgery, Arrhythmias, Cardiac - therapy, Atrioventricular Node - surgery, Cardiac Pacing, Artificial, Electric Countershock, Electrocardiography, Heart, Heart Rate - physiology, Heart Transplantation - adverse effects, Heart Transplantation - physiology

Add Comment 0 Comments

In Press

08 Mar 2024 : Original article  

Association of Coronary Calcium Score on Cardiac PET During Pre-Kidney Transplant Assessment with Persisten...

Ann Transplant In Press; DOI: 10.12659/AOT.943532  

14 Mar 2024 : Original article  

Impact of Blood Products Transfusion on Patients in the Immediate Post-Lung Transplant Period: A Cohort Study

Ann Transplant In Press; DOI: 10.12659/AOT.943652  

14 Mar 2024 : Case report  

Treatment of Cavernous Transformation of Portal Vein Caused by Hepatic Cystic Echinococcosis Using Ex Vivo ...

Ann Transplant In Press; DOI: 10.12659/AOT.942358  

15 Mar 2024 : Review article  

Approaches and Challenges in the Current Management of Cytomegalovirus in Transplant Recipients: Highlighti...

Ann Transplant In Press; DOI: 10.12659/AOT.941185  

Most Viewed Current Articles

05 Apr 2022 : Original article  

Impact of Statins on Hepatocellular Carcinoma Recurrence After Living-Donor Liver Transplantation

DOI :10.12659/AOT.935604

Ann Transplant 2022; 27:e935604

12 Jan 2022 : Original article  

Risk Factors for Developing BK Virus-Associated Nephropathy: A Single-Center Retrospective Cohort Study of ...

DOI :10.12659/AOT.934738

Ann Transplant 2022; 27:e934738

22 Nov 2022 : Original article  

Long-Term Effects of Everolimus-Facilitated Tacrolimus Reduction in Living-Donor Liver Transplant Recipient...

DOI :10.12659/AOT.937988

Ann Transplant 2022; 27:e937988

15 Mar 2022 : Case report  

Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...

DOI :10.12659/AOT.935860

Ann Transplant 2022; 27:e935860

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358