Little R E, Kay G N, Epstein A E, Plumb V J, Bourge R C, Neves J, Kirklin J K
Department of Medicine, University of Medicine, Birmingham 35294.
Circulation. 1989 Nov;80(5 Pt 2):III140-6.
The prevalence of arrhythmias after orthotopic cardiac transplantation in the era of cyclosporine immunosuppression is unknown. Accordingly, we analyzed telemetry data from the initial hospitalization period for 33 cardiac transplant procedures and from 100 hospital readmissions in 23 long-term survivors. Prevalence of arrhythmias was analyzed in relation to immunosuppressive regimen, occurrence of acute rejection, and other clinical and hemodynamic variables. Atrial and ventricular arrhythmias were recorded in 55% and 79% of patients during initial hospitalization and in 39% and 43% of long-term survivors, respectively. Compared with cyclosporine-treated patients, atrial (24% vs. 88%, p less than 0.001) and ventricular (65% vs. 94%, p = 0.085) arrhythmias during the initial hospitalization were more prevalent in patients receiving azathioprine. There was no difference in the prevalence of arrhythmias during initial hospitalization between patients experiencing acute rejection and those who did not. Potential associations between arrhythmia occurrence and a prolonged donor heart ischemic time (p = 0.022), elevated pulmonary arterial pressure (p = 0.01), and a lower ejection fraction (p = 0.009) were noted. These data suggest that arrhythmias occur in the majority of patients during the initial hospitalization for transplantation, even in those who never experience acute rejection. Ventricular arrhythmias are common in patients treated with either immunosuppressive regimen; however, atrial arrhythmias are less prevalent in patients receiving cyclosporine. Arrhythmias tend to occur in the setting of altered hemodynamics.
在环孢素免疫抑制时代，原位心脏移植术后心律失常的发生率尚不清楚。因此，我们分析了33例心脏移植手术初始住院期间以及23例长期存活者100次再次入院时的遥测数据。分析了心律失常的发生率与免疫抑制方案、急性排斥反应的发生以及其他临床和血流动力学变量之间的关系。在初始住院期间，分别有55%和79%的患者记录到房性和室性心律失常，在长期存活者中，这一比例分别为39%和43%。与接受环孢素治疗的患者相比，接受硫唑嘌呤治疗的患者在初始住院期间房性心律失常（24%对88%，p<0.001）和室性心律失常（65%对94%，p=0.085）更为普遍。发生急性排斥反应的患者与未发生急性排斥反应的患者在初始住院期间心律失常的发生率没有差异。注意到心律失常的发生与供体心脏缺血时间延长（p=0.022）、肺动脉压升高（p=0.01）和射血分数降低（p=0.009）之间存在潜在关联。这些数据表明，即使在那些从未经历过急性排斥反应的患者中，大多数患者在移植初始住院期间也会发生心律失常。无论采用哪种免疫抑制方案治疗，室性心律失常在患者中都很常见；然而，接受环孢素治疗的患者房性心律失常的发生率较低。心律失常往往发生在血流动力学改变的情况下。
