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Electroanatomical mapping and radiofrequency catheter ablation of atrial tachycardia originating from the donor heart after orthotopic heart transplantation in a child

  • Eivind Solheim
  • Morten Kristian Off
  • Per Ivar Hoff
  • Ole-Jørgen Ohm
  • Jian Chen
CASE REPORT

Abstract

A 15-year-old boy who had been given an orthotopic heart transplant 12 years earlier underwent radiofrequency ablation after 14 months of tachycardia. At the time of the procedure, the patient presented moderate signs of heart failure and tachycardia-induced cardiomyopathy. During electroanatomical mapping we identified a focal atrial tachycardia with origin in the donor right atrium and bi-directional atrio-atrial conduction. After successful focal ablation the patient had two alternating atrial activation patterns, representing the recipient and the donor heart sinus rhythm. Two months after the ablation heart failure symptoms were in regress, and the patient was still in sinus rhythm.

Keywords

Pediatrics Heart transplant Atrial tachycardia Electroanatomical mapping Radiofrequency ablation 

Notes

Acknowledgments

This study was partly supported by the Norwegian Foundation for Health and Rehabilitation and the Norwegian Council of Cardiovascular Diseases.

References

  1. 1.
    Vaseghi, M., Boyle, N. G., Kedia, R., Patel, J. K., Cesario, D. A., Wiener, I., et al. (2008). Supraventricular tachycardia after orthotopic cardiac transplantation. Journal of the American College of Cardiology, 51, 2241–2249.PubMedCrossRefGoogle Scholar
  2. 2.
    Birnie, D., Green, M. S., Veinot, J. P., Tang, A. S., & Davies, R. A. (2000). Interatrial conduction of atrial tachycardia in heart transplant recipients: potential pathophysiology. The Journal of Heart and Lung Transplantation, 19, 1007–1010.PubMedCrossRefGoogle Scholar
  3. 3.
    Gasparini, M., Mantica, M., Lunati, M., Andreuzzi, B., Turco, P., & Pellegrini, A. (1999). Congestive heart failure induced by recipient atrial tachycardia conducted to the donor atrium after orthotopic heart transplantation: complete regression after successful radiofrequency ablation. Journal of Cardiovascular Electrophysiology, 10, 399–404.PubMedCrossRefGoogle Scholar
  4. 4.
    Lefroy, D. C., Fang, J. C., Stevenson, L. W., Hartley, L. H., Friedman, P. L., & Stevenson, W. G. (1998). Recipient-to-donor atrioatrial conduction after orthotopic heart transplantation: surface electrocardiographic features and estimated prevalence. The American Journal of Cardiology, 82, 444–450.PubMedCrossRefGoogle Scholar
  5. 5.
    Magnano, A. R., & Garan, H. (2003). Catheter ablation of supraventricular tachycardia in the transplanted heart: a case series and literature review. Pacing and Clinical Electrophysiology, 26, 1878–1886.PubMedCrossRefGoogle Scholar
  6. 6.
    Saoudi, N., Redonnet, M., Anselme, F., Poty, H., & Cribier, A. (1998). Catheter ablation of atrioatrial conduction as a cure for atrial arrhythmia after orthotopic heart transplantation. Journal of the American College of Cardiology, 32, 1048–1055.PubMedCrossRefGoogle Scholar
  7. 7.
    Ribbing, M., Monnig, G., Wasmer, K., Breithardt, G., & Eckardt, L. (2004). Catheter ablation of atrial tachycardia due to recipient-to-donor transatrial conduction after orthotopic heart transplantation. Europace, 6, 215–219.PubMedCrossRefGoogle Scholar
  8. 8.
    Khan, M., Kalahasti, V., Rajagopal, V., Khaykin, Y., Wasni, O., Almahameed, S., et al. (2006). Incidence of atrial fibrillation in heart transplant patients: long-term follow-up. Journal of Cardiovascular Electrophysiology, 17, 827–831.PubMedCrossRefGoogle Scholar
  9. 9.
    Marine, J. E., Bogun, F., Krishnan, S. C., & Schuger, C. D. (2004). Supraventricular tachycardia in a heart transplant recipient: what is the mechanism? Heart Rhythm, 1, 632–633.PubMedCrossRefGoogle Scholar
  10. 10.
    Li, Y. G., Bender, B., Gronefeld, G., & Hohnloser, S. H. (1999). Atrial flutter in the recipient atrium induced by premature beats arising from the donor atrium 10 years after orthotopic heart transplantation. Europace, 1, 275–279.PubMedCrossRefGoogle Scholar
  11. 11.
    Ross, M., Kouretas, P., Gamberg, P., Miller, J., Burge, M., Reitz, B., et al. (2006). Ten- and 20-year survivors of pediatric orthotopic heart transplantation. The Journal of Heart and Lung Transplantation, 25(3), 261–270.PubMedCrossRefGoogle Scholar
  12. 12.
    Ott, P., Kelly, P. A., Mann, D. E., Damle, R. S., Reiter, M. J., & Lindefeld, J. (1995). Tachycardia-induced cardiomyopathy in a cardiac transplant recipient: treatment with radiofrequency catheter ablation. Journal of Cardiovascular Electrophysiology, 6, 391–395.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Eivind Solheim
    • 1
  • Morten Kristian Off
    • 1
  • Per Ivar Hoff
    • 1
  • Ole-Jørgen Ohm
    • 1
  • Jian Chen
    • 1
  1. 1.Institute of Medicine, Department of Heart Disease, Haukeland University HospitalUniversity of BergenBergenNorway

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