BACKGROUND: Ventricular fibrillation (VF) is the primary mechanism of cardiac arrest in the vast majority of sudden death patients. Whether similar modes and mechanisms of death can be generalized to denervated hearts in orthotopic heart transplantation (OHT) patients is unknown. OBJECTIVE: The purpose of this study was to determine the mode and mechanisms of death in patients who have undergone cardiac transplantation. METHODS: We analyzed the outcomes of 628 patients who underwent OHT between January 1994 and December 2004. The mode of death was classified as either sudden death (SD) or non-sudden death (NSD). The first documented rhythm taken at the time of arrest was also reviewed to determine the mechanism of cardiac arrest. RESULTS: During a mean follow-up of 76 months, 194 patients died. Of these, the mode of death could be determined in 116 patients (60%). Forty-one patients (35%) died of SD, and 75 patients (65%) died of NSD. The first documented rhythm of death was available in 91 patients (26 SD and 65 NSD). The terminal rhythms in patients who died suddenly were: asystole (34%), pulseless electrical activity (PEA) (20%), and VF (10%). In NSD patients, the terminal rhythms were asystole (73%), followed by VF (7%), and PEA (7%), P < .001 compared with SD patients. CONCLUSION: SD represented the mode of death in 35% of OHT patients. The main mechanisms underlying SD in this population were asystole and PEA, suggesting that denervation of the donor heart, among other post-transplantation changes, may alter susceptibility to VF.
BACKGROUND:Ventricular fibrillation (VF) is the primary mechanism of cardiac arrest in the vast majority of sudden deathpatients. Whether similar modes and mechanisms of death can be generalized to denervated hearts in orthotopic heart transplantation (OHT) patients is unknown. OBJECTIVE: The purpose of this study was to determine the mode and mechanisms of death in patients who have undergone cardiac transplantation. METHODS: We analyzed the outcomes of 628 patients who underwent OHT between January 1994 and December 2004. The mode of death was classified as either sudden death (SD) or non-sudden death (NSD). The first documented rhythm taken at the time of arrest was also reviewed to determine the mechanism of cardiac arrest. RESULTS: During a mean follow-up of 76 months, 194 patients died. Of these, the mode of death could be determined in 116 patients (60%). Forty-one patients (35%) died of SD, and 75 patients (65%) died of NSD. The first documented rhythm of death was available in 91 patients (26 SD and 65 NSD). The terminal rhythms in patients who died suddenly were: asystole (34%), pulseless electrical activity (PEA) (20%), and VF (10%). In NSDpatients, the terminal rhythms were asystole (73%), followed by VF (7%), and PEA (7%), P < .001 compared with SDpatients. CONCLUSION:SD represented the mode of death in 35% of OHT patients. The main mechanisms underlying SD in this population were asystole and PEA, suggesting that denervation of the donor heart, among other post-transplantation changes, may alter susceptibility to VF.
Authors: J M Cao; M C Fishbein; J B Han; W W Lai; A C Lai; T J Wu; L Czer; P L Wolf; T A Denton; I P Shintaku; P S Chen; L S Chen Journal: Circulation Date: 2000-04-25 Impact factor: 29.690
Authors: J M Cao; L S Chen; B H KenKnight; T Ohara; M H Lee; J Tsai; W W Lai; H S Karagueuzian; P L Wolf; M C Fishbein; P S Chen Journal: Circ Res Date: 2000-04-14 Impact factor: 17.367
Authors: Chavit Chantranuwat; John D Blakey; Jon A Kobashigawa; Jaime D Moriguchi; Hillel Laks; Maria Espejo Vassilakis; Michael C Fishbein Journal: J Heart Lung Transplant Date: 2004-06 Impact factor: 10.247
Authors: Kalyanam Shivkumar; Olujimi A Ajijola; Inder Anand; J Andrew Armour; Peng-Sheng Chen; Murray Esler; Gaetano M De Ferrari; Michael C Fishbein; Jeffrey J Goldberger; Ronald M Harper; Michael J Joyner; Sahib S Khalsa; Rajesh Kumar; Richard Lane; Aman Mahajan; Sunny Po; Peter J Schwartz; Virend K Somers; Miguel Valderrabano; Marmar Vaseghi; Douglas P Zipes Journal: J Physiol Date: 2016-06-14 Impact factor: 5.182
Authors: Kevin P Daly; Sujata B Chakravarti; Margaret Tresler; David C Naftel; Elizabeth D Blume; Anne I Dipchand; Christopher S Almond Journal: J Heart Lung Transplant Date: 2011-10-13 Impact factor: 10.247
Authors: J L Ardell; M C Andresen; J A Armour; G E Billman; P-S Chen; R D Foreman; N Herring; D S O'Leary; H N Sabbah; H D Schultz; K Sunagawa; I H Zucker Journal: J Physiol Date: 2016-06-17 Impact factor: 5.182