Lefroy D C, Fang J C, Stevenson L W, Hartley L H, Friedman P L, Stevenson W G
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Am J Cardiol. 1998 Aug 15;82(4):444-50. 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 < or = 10% of patients late after heart transplantation. It is a potential cause of arrhythmias that can be effectively treated with radiofrequency catheter ablation.
原位心脏移植术后，经缝合线的受者至供者心房传导鲜有报道。这种传导与症状性心律失常的关系及其发生率尚不清楚。在一名28岁女性原位心脏移植术后7年发生阵发性室上性心动过速的患者中，证实了存在受者至供者心房传导。受者心房的房性心动过速以2:1比例传导至供者心房，通过对左侧心房电连接进行射频导管消融得以消除。在消融受者至供者连接之前记录的静息和运动时心电图显示，频繁出现房性早搏，与先前窦性搏动的偶联可变，运动时P波形态改变，恢复期恢复正常。消融受者至供者连接后这些表现消失。为了确定移植后期受者至供者心房传导的发生率，我们评估了50名心脏移植术后超过5年的受试者的运动心电图，以寻找受者至供者传导的这些特征。5名受试者至少存在1项特征，1名受试者两项特征均存在。心房内可经手术缝合线发生电传导。心脏移植后期，受者至供者心房传导可能发生在≤10%的患者中。它是心律失常的一个潜在原因，可通过射频导管消融有效治疗。
