BACKGROUND: The standard technique for orthotopic heart transplantation includes right and left atrial anastomoses, which potentially disturb the integrity of the donor atria. Consequently, electrophysiologic abnormalities such as atrial flutter and fibrillation may occur even late after heart transplanation. METHODS: Over a 3-year period, 39 heart transplantations were performed using a standard right atrial anastomosis (group A), and 40 were done using bicaval anastomoses (group B). In each group, data of 30 consecutive patients with a minimum follow-up of 9 months were reviewed retrospectively to assess the incidence of atrial arrhythmia after hospital discharge. RESULTS: Early postoperatively, there was no difference in the duration of temporary pacemaker requirement and incidence of permanent pacemaker implantation (group A, 7%; group B, 7%; not significant) between the two groups. In 12 patients in group A (40%), 16 episodes of atrial flutter and fibrillation were detected 20 to 205 days after heart transplantation. In group B, 1 patient (4%) suffered from atrial fibrillation on day 116 after the operation (p < 0.001). CONCLUSIONS: Preservation of the integrity of the right donor atrium by construction of bicaval anastomoses results in a significantly decreased incidence of atrial flutter and fibrillation after heart transplantation when compared with the standard technique.
BACKGROUND: The standard technique for orthotopic heart transplantation includes right and left atrial anastomoses, which potentially disturb the integrity of the donor atria. Consequently, electrophysiologic abnormalities such as atrial flutter and fibrillation may occur even late after heart transplanation. METHODS: Over a 3-year period, 39 heart transplantations were performed using a standard right atrial anastomosis (group A), and 40 were done using bicaval anastomoses (group B). In each group, data of 30 consecutive patients with a minimum follow-up of 9 months were reviewed retrospectively to assess the incidence of atrial arrhythmia after hospital discharge. RESULTS: Early postoperatively, there was no difference in the duration of temporary pacemaker requirement and incidence of permanent pacemaker implantation (group A, 7%; group B, 7%; not significant) between the two groups. In 12 patients in group A (40%), 16 episodes of atrial flutter and fibrillation were detected 20 to 205 days after heart transplantation. In group B, 1 patient (4%) suffered from atrial fibrillation on day 116 after the operation (p < 0.001). CONCLUSIONS: Preservation of the integrity of the right donor atrium by construction of bicaval anastomoses results in a significantly decreased incidence of atrial flutter and fibrillation after heart transplantation when compared with the standard technique.
Authors: Bharat K Kantharia; Sabrina L Wilbur; Steven P Kutalek; Farooq A Padder Journal: J Interv Card Electrophysiol Date: 2005-01 Impact factor: 1.900
Authors: Srinivasan Sattiraju; Shashank Vats; Balaji Krishnan; Sun K Kim; Erin Austin; Ilknur Can; Venkatakrishna Tholakanahalli; David G Benditt; Lin Y Chen Journal: J Atr Fibrillation Date: 2012-12-16
Authors: Makoto Tonsho; Sebastian Michel; Zain Ahmed; Alessandro Alessandrini; Joren C Madsen Journal: Cold Spring Harb Perspect Med Date: 2014-05-01 Impact factor: 6.915
Authors: Anees Thajudeen; Eric C Stecker; Michael Shehata; Jignesh Patel; Xunzhang Wang; John H McAnulty; Jon Kobashigawa; Sumeet S Chugh Journal: J Am Heart Assoc Date: 2012-04-24 Impact factor: 5.501