Ventricular Tachycardia Late After Cardiac Transplantation
A 65-year-old man presented with 48 hours of palpitations. His ECG on admission demonstrated a broad-complex tachycardia (Figure 1). Eleven years previously he had undergone heterotopic cardiac transplantation for severe ischemic cardiomyopathy. Echocardiography demonstrated a normally contracting donor heart (left ventricular [LV] end-diastolic diameter 41 mm, LV ejection fraction 62%). On the contrary, the native heart showed no movement of the mitral valve with tremulations of the left ventricular walls (LV end-diastolic diameter 85 mm, LV ejection fraction 0%). A cardioversion was performed to restore sinus rhythm symptom control (Figure 2). Echocardiography of the native heart during sinus rhythm (Figure 3) demonstrated organized mechanical activity of the left ventricle despite a very poor contractility (global severe hypokinesia with permanent moderate [II] mitral insufficiency, EF 9%).
Long-term follow-up in patients with heterotopic heart transplant may be associated with complications related to the native heart such as arrhythmias, thromboembolisms, valvular heart disease, or worsening of ischemic heart disease.1 Ventricular tachycardia can be found in up to 25% of the patients on a 4-year follow-up.1 Given the frequency of this diagnosis in patients with heterotopic heart transplant, it is of particular interest to recognize this unusual though characteristic ECG pattern.