Counter-clockwise Atrial Flutter in the Donor’s Right Atrium After Heart Transplantation: a Peculiar Example of Single-Loop Right Atrial Reentry


This is a 75-year-old male patient who, 17 years earlier, underwent an orthotopic heart transplantation for idiopathic dilated cardiomyopathy, carried out according to the Lower and Shumway technique. In this technique, large portions of the recipient’s right and left atria are kept in place and an atrio-atrial anastomosis is performed with the donor’s atria. Before transplantation, the patient was in sinus rhythm with complete left bundle branch block. Early after transplantation, the patient exhibited sinus-node dysfunction with the appearance of junctional rhythm; for this reason, a VVI pacemaker was eventually implanted. Over the 3 months prior to examination in our centre, the patient had suffered recurrent episodes of persistent palpitations. An electrocardiogram during palpitations documented atrial flutter with a P wave morphology resembling that of typical atrial flutter (Fig. 1), although the classical “sawtooth” morphology was not present. The arrhythmia had predominantly a 2:1 atrioventricular conduction. After two episodes terminated by electrical cardioversion, the arrhythmia recurred; for this reason, the patient was admitted for an electrophysiologic procedure.


Coronary Sinus Atrial Flutter Atrial Tachycardia Tricuspid Annulus Orthotopic Heart Transplantation 
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© Springer-Verlag Italia 2008

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