Silent Ischemia and Arrhythmia after Heart Transplantation: Relation to Cardiac Allograft Vasculopathy

Purpose Sudden cardiac death (SCD) is a frequent and unexplained complication in relation to heart transplantation (HTx). The mechanism is expectedly multifactorial and Cardiac Allograft Vasculopathy (CAV) is possibly related to SCD. We aimed to investigate the relation between CAV and arrhythmias and silent ischemia in long-term HTx patients. Methods CAV was classified in accordance with the International Society of Heart and Lung Transplantation guideline by coronary angiography and echocardiography . Patients were divided into three CAV groups (CAV 0, 1 and 2+3). Incidence of arrhythmias and silent ischemia were detected by 48-hour electrocardiogram monitoring , and analyzed blinded to CAV status. Results We included 49 HTx patients transplanted a median of 9 years ago [4-14]. We saw a higher incidence of nonsustained ventricular tachycardia (NSVT) in CAV 2+3 patients than in CAV 0 and 1 patients (p=0.01). Also, isolated premature ventricular contractions (PVC) were more frequently observed in this group than in CAV 0 and 1 patients (p=0.01). No difference in incidence of isolated premature atrial contractions (p=0.67) and supraventricular tachycardia (p=0.13) was observed between the CAV groups. Silent ischemia was only observed in CAV 2+3 patients (p=0.04), all patients with silent ischemia (n=3) died within 12 months. The PQ-interval was increased in CAV patients compared with patients without CAV (p=0.01) but no episodes of advanced AV-block were detected. Conclusion Patients with substantial CAV showed a higher incidence of PVCs and NSVT. However, the burden of ventricular rhythm-disturbances was modest and not clearly indicating an increased risk of SCD. In contrast, presence of silent ischemia in patients with severe CAV was associated with high mortality.