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(Circulation. 1999;99:326-327.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Atrial Reentrant Tachycardia After Heart Transplantation

Ellen Hoffmann, MD; Christopher Reithmann, MD; Petra Nimmermann, MD; Thomas Remp, MD; Gerhard Steinbeck, MD

From Medical Hospital I, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.

Correspondence to Ellen Hoffmann, MD, Klinikum Grosshadern, Ludwig-Maximilians-University, 81366 Munich, Germany.

A68-year-old man presented with an incessant supraventricular tachycardia 3 months after heart transplantation. A dual-chamber pacemaker had been implanted immediately after surgery for bradyarrhythmias. Electrophysiological study was performed with a multipolar halo catheter (20 electrode pairs) in the right atrium and bi- or quadripolar catheters in a high lateral, His, and coronary sinus ostium position of the right atrium (Figure, top right). An atrial reentrant tachycardia was depicted in the transplanted atrium from the proximal recordings of the halo (electrodes 17, 18 to 9, 10), while simultaneously, sinus rhythm of the remaining right atrium of the recipient heart could be recorded from the distal halo electrodes (5, 6 to 1, 2), with both rhythms overlapping at electrodes 7, 8 (Figure, top left).

View larger version (57K): [in this window] [in a new window]   Figure 1.

The CARTO mapping system provides a three-dimensional electroanatomic reconstruction of the heart chamber and a color-coded representation of the endocardial activation sequence. We mapped 15 points of the "old" atrium during sinus rhythm, giving the typical picture of a "focal" atrial activation sequence of the sinus node (Figure, bottom left). Of the "new" transplanted atrium, 111 positions were mapped during the ongoing atrial tachycardia, visualizing the typical signs of a macroreentrant tachycardia with adjacent sites of the earliest (red) and latest (violet) local activation (Figure, bottom right).

Curative radiofrequency catheter ablation of the reentrant tachycardia was primarily successful. However, atrial tachyarrhythmias recurred 3 months after the ablation. Because signs of tachycardiomyopathy developed, we decided to perform His bundle ablation as a definitive treatment. Six months later, the patient has normal heart function and is free of tachyarrhythmia recurrences.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This article has been cited by other articles:

				C. Reithmann, E. Hoffmann, U. Dorwarth, T. Remp, and G. Steinbeck Electroanatomical mapping for visualization of atrial activation in patients with incisional atrial tachycardias Eur. Heart J., February 1, 2001; 22(3): 237 - 246. [Abstract] [PDF]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hoffmann, E. Articles by Steinbeck, G. Search for Related Content PubMed PubMed Citation Articles by Hoffmann, E. Articles by Steinbeck, G. Related Collections Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs