Vaseghi Marmar, Boyle Noel G, Kedia Rohit, Patel Jignesh K, Cesario David A, Wiener Isaac, Kobashigawa Jon A, Shivkumar Kalyanam
UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA.
J Am Coll Cardiol. 2008 Jun 10;51(23):2241-9. doi: 10.1016/j.jacc.2008.02.065.
The purpose of this study was to define the incidence, mechanisms, and management, including catheter ablation, of supraventricular tachycardia (SVT) in a large series of patients after orthotopic heart transplantation (OHT).
Supraventricular arrhythmias are frequently encountered after OHT, but their characteristics in this population have not been well established.
We analyzed the incidence, clinical course, and management of SVTs in a cohort of 729 adult patients who underwent OHT. Furthermore, the mechanisms of arrhythmias among the patients referred for electrophysiological study (EPS) and ablation were also characterized.
The most common arrhythmia was atrial flutter, which occurred in 9% of this cohort. Persistent or paroxysmal atrial fibrillation occurred in 7%, the majority (57%) in the perioperative period. Persistent or paroxysmal atrial fibrillation was observed in OHT patients, beyond the post-operative period, only in the presence of rejection or transplant vasculopathy. Other persistent or paroxysmal SVTs were seen in 47 stable OHT patients (7%). Of these, 24 patients (4%) underwent EPS. Accessory and dual atrioventricular nodal pathways in the donor heart caused SVT in 3 patients. Macro-reentrant atrial tachycardia was seen in 7 patients, and isthmus-dependent atrial flutter occurred in 14 patients.
The majority of SVTs in stable OHT patients can be attributed to macro-reentrant tachycardias (flutter and scar reentry). Catheter ablation is effective in management of these SVTs. Atrial fibrillation was never encountered in stable patients in our series, and its occurrence should prompt an evaluation for acute rejection and/or vasculopathy.
本研究旨在明确大量原位心脏移植（OHT）术后患者室上性心动过速（SVT）的发生率、机制及治疗方法，包括导管消融治疗。
OHT术后常出现室上性心律失常，但其在该人群中的特征尚未完全明确。
我们分析了729例接受OHT的成年患者队列中SVT的发生率、临床过程及治疗情况。此外，还对接受电生理检查（EPS）和消融治疗的患者心律失常机制进行了分析。
最常见的心律失常是心房扑动，在该队列中发生率为9%。持续性或阵发性心房颤动发生率为7%，其中大部分（57%）发生在围手术期。仅在存在排斥反应或移植血管病变时，OHT患者在术后还会出现持续性或阵发性心房颤动。47例稳定的OHT患者（7%）出现其他持续性或阵发性SVT。其中，24例患者（4%）接受了EPS检查。供体心脏中的附加和双房室结通路导致3例患者发生SVT。7例患者出现大折返性房性心动过速，14例患者出现峡部依赖性心房扑动。
稳定的OHT患者中，大多数SVT可归因于大折返性心动过速（扑动和瘢痕折返）。导管消融治疗对这些SVT有效。在我们的系列研究中，稳定患者从未出现过心房颤动，其出现应促使对急性排斥反应和/或血管病变进行评估。
