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Management of Arrhythmias After Heart Transplant: Current State and Considerations for Future Research.
- Source :
-
Circulation. Arrhythmia and electrophysiology [Circ Arrhythm Electrophysiol] 2021 Mar; Vol. 14 (3), pp. e007954. Date of Electronic Publication: 2021 Mar 09. - Publication Year :
- 2021
-
Abstract
- Orthotropic heart transplantation remains the most effective therapy for patients with end-stage heart failure, with a median survival of ≈13 years. Yet, a number of complications are observed after orthotropic heart transplantation, including atrial and ventricular arrhythmias. Several factors contribute to arrhythmias, such as autonomic denervation, effect of the surgical technique, acute and chronic rejection, and transplant vasculopathy among others. To minimize risk of future arrhythmias, the bicaval technique and minimizing ischemic time are current surgical standards. Sinus node dysfunction is the most common indication for early (within 30 days) pacemaker implantation, whereas atrioventricular block incidence increases as time from transplant increases. Atrial fibrillation can occur in the first few weeks following transplantation but is uncommon in the long term unless secondary to a precipitant such as acute rejection. The most common atrial arrhythmias are atrial flutters, which are mainly typical, but atypical circuits can be observed such as those that involve the remnant donor atrium in regions immediately adjacent to the atrioatrial anastomosis suture line. Choosing the appropriate pharmacological therapy requires careful consideration due to the potential interaction with immunosuppressive agents. Despite historical concerns, adenosine is effective and safe at reduced doses if administered under cardiac monitoring. Catheter ablation has emerged as an effective treatment strategy for symptomatic supraventricular tachycardias, including ablation of atypical flutter circuits. Cardiac allograft vasculopathy is an important risk factor for sudden cardiac death, yet the role of prophylactic implantable cardioverter-defibrillator implant for sudden death prevention is unclear. Current indications for implantable cardioverter-defibrillator implantation are as in the nontransplant population. A number of questions for future research are posed.
- Subjects :
- Action Potentials
Animals
Anti-Arrhythmia Agents adverse effects
Arrhythmias, Cardiac etiology
Arrhythmias, Cardiac mortality
Arrhythmias, Cardiac physiopathology
Defibrillators, Implantable
Heart Transplantation mortality
Humans
Risk Factors
Treatment Outcome
Anti-Arrhythmia Agents therapeutic use
Arrhythmias, Cardiac therapy
Catheter Ablation adverse effects
Catheter Ablation mortality
Electric Countershock adverse effects
Electric Countershock instrumentation
Electric Countershock mortality
Heart Rate drug effects
Heart Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1941-3084
- Volume :
- 14
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Circulation. Arrhythmia and electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 33685207
- Full Text :
- https://doi.org/10.1161/CIRCEP.120.007954