Scott C D, Dark J H, McComb J M
Cardiothoracic Center, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Am J Cardiol. 1992 Oct 15;70(11):1061-3. doi: 10.1016/0002-9149(92)90361-2.
The etiology and clinical significance of sustained arrhythmias, and atrial and ventricular premature complexes (APCs and VPCs, respectively) after heart transplantation are controversial. Fifty adult recipients surviving > 2 weeks were studied by continuous telemetry while in the hospital and by ambulatory electrocardiographic monitoring at 2, 4, 6, 12 and 24 weeks after transplantation. The median APC frequency was greater among subjects who experienced allograft rejection in the early postoperative period (0.7/hour, range 0 to 23) than among those who did not (0.2/hour, range 0 to 10.4) (p = 0.04). The APC frequency in all subjects decreased from 0.25/hour (range 0 to 23) early to 0/hour (0 to 14) later (p = 0.04). Atrial flutter was the most frequent sustained arrhythmia; it was recorded in 5 of 21 rejectors and in 1 of 29 nonrejectors (p = 0.04), and 11 of 16 episodes (69%) were related to acute rejection temporally. VPCs were recorded in all patients early after transplantation, but the median frequency subsequently decreased from 4.6/hour (range 0.5 to 470) early to 1.25/hour (range 0 to 225) later (p < 0.001). VPC frequency was unrelated to rejection. Sustained ventricular tachycardia was recorded once and was caused by the proarrhythmic effect of flecainide. Thus, APCs and VPCs occur frequently after transplantation. Frequent APCs are associated with rejection, whereas the main determinant of VPC frequency is time after transplantation. Atrial flutter is closely associated with rejection and should be regarded as an indication for endomyocardial biopsy. Ventricular tachycardia occurs seldom, and in this study was due to proarrhythmic drug effects.
心脏移植后持续性心律失常以及房性和室性早搏复合体（分别为房性早搏和室性早搏）的病因及临床意义存在争议。对50名存活超过2周的成年受者进行了研究，住院期间通过连续遥测进行监测，并在移植后2周、4周、6周、12周和24周进行动态心电图监测。术后早期发生移植排斥反应的受试者中，房性早搏的中位频率（0.7次/小时，范围0至23次）高于未发生排斥反应的受试者（0.2次/小时，范围0至10.4次）（p = 0.04）。所有受试者的房性早搏频率从早期的0.25次/小时（范围0至23次）降至后期的0次/小时（0至14次）（p = 0.04）。心房扑动是最常见的持续性心律失常；21名发生排斥反应者中有5例记录到心房扑动，29名未发生排斥反应者中有1例记录到心房扑动（p = 0.04），16次发作中有11次（69%）在时间上与急性排斥反应相关。所有患者在移植后早期均记录到室性早搏，但随后中位频率从早期的4.6次/小时（范围0.5至470次）降至后期的1.25次/小时（范围0至225次）（p < 0.001）。室性早搏频率与排斥反应无关。记录到1次持续性室性心动过速，是由氟卡尼的促心律失常作用引起的。因此，移植后房性早搏和室性早搏频繁发生。频繁的房性早搏与排斥反应相关，而室性早搏频率的主要决定因素是移植后的时间。心房扑动与排斥反应密切相关，应被视为心内膜活检的指征。室性心动过速很少发生，在本研究中是由促心律失常药物作用所致。
