Supraventricular tachycardia after orthotopic cardiac transplantation.
Supraventricular tachycardia after orthotopic cardiac transplantation.
复制标题
原位心脏移植后室上性心动过速。
DOI：
10.1016/j.jacc.2008.02.065
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发表时间：
2008
影响因子：
24
通讯作者：
Shivkumar,Kalyanam
中科院分区：
文献类型：
--
作者：
Vaseghi,Marmar;Boyle,NoelG;Kedia,Rohit;Patel,JigneshK;Cesario,DavidA;Wiener,Isaac;Kobashigawa,JonA;Shivkumar,Kalyanam
本研究的目的是确认室上性心动过速(SVT)在大量原位心脏移植(OHT)患者中的发生率、发生机制和处理方法，包括导管消融。背景OHT后常见的室上性心律失常，但其特点在这一人群中尚未被很好地建立。结果最常见的心律失常是心房扑动，发生率为9%。持续性或阵发性房颤发生率为7%，多数(57%)发生在围手术期。在OHT患者中，只有在存在排斥反应或移植血管病变的情况下，才能在手术后观察到持续性或阵发性心房颤动。47例稳定期OHT患者(7%)可见其他持续性或阵发性室上性心动过速。其中，24名患者(4%)接受了EPS。供心旁道和房室结双径路引起3例室上性心动过速。7例出现巨大折返性房性心动过速，14例出现峡部依赖性心房扑动。结论稳定型OHT患者的室上性心动过速多为巨大折返性心动过速(扑动和疤痕折返)。导管消融是治疗这些室上性心动过速的有效方法。在我们的系列中，稳定的患者中从未遇到过心房颤动，它的发生应该促使对急性排斥反应和/或血管病变进行评估。
ObjectivesThe 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).BackgroundSupraventricular arrhythmias are frequently encountered after OHT, but their characteristics in this population have not been well established.MethodsWe 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.ResultsThe 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.ConclusionsThe 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.