P1883Arrhythmias in transplanted hearts: Lessons from Europes largest cohort of patients who underwent orthotopic heart transplantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Bergau ◽  
M El-Hamriti ◽  
S Molatta ◽  
K Alzain ◽  
V Rubesch-Kuetemeyer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Transplantation ◽  
Large Cohort ◽  
Background Information ◽  
Orthotopic Heart Transplantation ◽  
Atrial Ablation ◽  
Successful Transplantation ◽  
History Of ◽  
Atrial Fibrillation And Flutter ◽  
Supraventricular Tachycardias

Abstract Introduction Cardiac arrhythmias are regulary seen in patients following orthotopic heart transplantation (OHT). So far, there is no data available about the prevalence in a large cohort. Methods We retrospectively screened our database for subjects with OHT who received inpatient or outpatient treatment in our center between January 2000 and December 2018. All these patients were carefully reviewed with special attention to rhythm disturbances after successful transplantation. Results We identified a total number of 1890 subjects with history of OHT being treated in our center during the pre-defined time-period. The prevalence of supraventricular tachycardias was as follows: atrial fibrillation/atypical flutter and atrial ectopy 10%, AV-node-re-entry tachycardia 3%, typical atrial flutter 2% and higher degree AV-Block or Sick-Sinus-Syndrom (SSS) was 6%. Sustained ventricular tachycardia or ventricular premature contractions were present in 2%. Regarding the patients with arrhythmias, 13% received catheter ablation for arrhythmias, thereof 53% an atrial ablation (24% left atrial ablation), the remainder received a ventricular ablation. Conclusion In this very large cohort and following a long observational time, there was a higher incidence of atrial arrhythmias in patients following OHT as reported in healthy subjects with an emphasis on atrial fibrillation and flutter. This data gives a valuable background information on morbidity following OHT.

scholarly journals Sudden cardiac arrest after late permanent pacemaker implantation in a heart transplant patient

2021 ◽  
Vol 0 (Ahead of Print) ◽  
Author(s):  
Yavuzer Koza ◽  
Oguzhan Birdal ◽  
Sidar Siyar Aydın ◽  
Ferih Ozcanlı ◽  
Hakan Tas
Keyword(s):  
Heart Transplantation ◽  
Transplant Patient ◽  
Cardiopulmonary Arrest ◽  
Sudden Cardiac Arrest ◽  
Pacemaker Implantation ◽  
Early Period ◽  
Permanent Pacemaker ◽  
Orthotopic Heart Transplantation ◽  
History Of ◽  
Pulse Steroid

Bradycardia during the early period following heart transplantation frequently occurs with an incidence of 14 to 44% and it is usually self-limited. The incidence of late bradycardia (from 30 days to more than 5 or 6 months after transplantation) has been reported to be 1.5%. A 33-year-old male patient with a history of orthotopic heart transplantation in 2013 presented with complaints of dizziness and near syncope. A DDDR permanent pacemaker was implanted for sinus pauses exceeding 3 seconds recorded on Holter examination. Shortly after the procedure, he developed sudden cardiovascular collapse. Cardiopulmonary resuscitation was performed and a pulse steroid treatment (2 grams of methylprednisolone) was given. After 2 days, the patient was extubated. While making preparations for re-transplantation, cardiopulmonary arrest developed again and he died. Sinus pause may be a clue for rejection and is an important finding in predicting clinical course.

scholarly journals The effect of a donor's history of active substance on outcomes following orthotopic heart transplantation☆

2007 ◽  
Vol 31 (3) ◽  
pp. 452-456 ◽  
Author(s):  
Kenneth J. Shea ◽  
Nikolai A Sopko ◽  
Kristin Ludrosky ◽  
Katherine Hoercher ◽  
Nicholas G. Smedira ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Active Substance ◽  
Orthotopic Heart Transplantation ◽  
History Of

scholarly journals P110: A prospective cohort study to evaluate sex differences in presentations and management for patients presenting to emergency departments with atrial fibrillation and flutter

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S95-S96
Author(s):  
B. H. Rowe ◽  
S. Patrick ◽  
P. Duke ◽  
K. Lobay ◽  
M. Haager ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Emergency Departments ◽  
Oral Anticoagulants ◽  
Chi Square ◽  
University Of Alberta ◽  
Before And After ◽  
History Of ◽  
Atrial Fibrillation And Flutter

Introduction: Atrial fibrillation and flutter (AFF) represent the most common arrhythmia presentations to emergency departments (EDs). Some research suggests that women with AFF experience different symptoms, receive different treatment and have worse outcomes than men. This study explored sex differences in risk factors, medication, and outcomes before and after ED visits for acute AFF. Methods: Adult patients presenting to the one of three hospitals affiliated with the University of Alberta with acute AFF were enrolled. Following informed consent, each patient completed a survey administered by a trained researcher, administrative ED information (e.g., ED times) was collected from the ED information system, a chart review on treatments was conducted and patients were contacted for follow-up at 7 days via telephone. Descriptive (median and interquartile range {IQR} and proportions) and simple (Wilcoxon-Mann-Whitney, chi-square, z-proportion) statistics are presented for continuous and dichotomous outcomes. Results: Overall, 217 patients were enrolled; the median age was 64 years (IQR: 55, 73) and 39% were female. Males presenting to the ED with AFF were 10 years younger than females (p<0.001); however, females weighed significantly less (median weight 69 vs. 95 kg; p<0.001), consumed less alcohol (12 vs 60 drinks/year; p<0.001) and were less likely to be ex-smokers (p=0.022) than men with AFF. Women arrived by Emergency Medical Services (EMS) (p=0.037), experienced palpitations (p=0.042), and reported a history of hypertension (p=0.022) more frequently than men. Females were more often prescribed oral anticoagulants before (p= 0.041) and after (p=0.011) the ED visit, and females with a history of AFF were less likely to present without anticoagulant/antiplatelet therapy (p=0.015). Overall, both sexes had similar attempts at cardioversion (59.4% vs. 61.3%) and hospitalizations (12.5% vs. 8.6%), respectively. If initial chemical cardioversion failed, females were more likely to receive subsequent electrical cardioversion (60.0% vs. 26.7%, p=0.036) than men. Conclusion: Overall, both women and men present frequently to the ED with AFF. Compared to men with AFF, women present with symptoms 10 years later, have different risk factors, experience more severe symptoms and use EMS more commonly; however, outcomes were similar. Unexplained sex-based variations in-ED and post-ED management are evident and these differences warrant further scrutiny.

Heterotopic Heart Transplantation: The United States Experience

2014 ◽  
Vol 17 (3) ◽  
pp. 132 ◽  
Author(s):  
Jama Jahanyar ◽  
Michael M. Koerner ◽  
Ali Ghodsizad ◽  
Matthias Loebe ◽  
George P. Noon
Keyword(s):  
United States ◽  
Heart Transplantation ◽  
The United States ◽  
Orthotopic Heart Transplantation ◽  
Size Mismatch ◽  
Heterotopic Heart Transplantation ◽  
Feasible Option ◽  
History Of ◽  
States Experience ◽  
Or History

<p><b>Introduction:</b> More than 3 decades have passed since the first heterotopic heart transplantation (HHT) was reported. Nowadays, this surgical technique is used rarely, and only in patients who do not qualify for standard orthotopic heart transplantation (OHT). Current indications mainly comprise refractory pulmonary hypertension and a donor-recipient size mismatch (>20%). The objective of this study was to analyze the United States experience with HHT.</p><p><b>Patients and Methods:</b> The United Network for Organ Sharing (UNOS) database between 1987 and 2007 was analyzed. Patients who underwent heart transplantation were enrolled in this study. Patients with missing transplant dates or history of retransplantation were excluded.</p><p><b>Results:</b> A total of 41,379 patients underwent OHT and 178 HHT; 32,361 and 111 patients, respectively, were enrolled. Overall 1-, 5-, and 10-year survival was significantly (<i>P</i> < .001) better in OHT (87.7%, 74.4%, 54.4%) than HHT patients (83.8%, 59%, 35.1%). Survival in patients with transpulmonary gradients (TPG) >15 mmHg was 86.6 %, 73.3%, and 57.4% in the OHT and 93.8%, 64.8%, and 48.6% in the HHT group (<i>P</i> = .35). Pretransplant criteria (HHT versus OHT) with statistically significant differences (<i>P</i> < .05) were as follows (mean + SD): recipient weight, 78.9 + 19.9 versus 74.1 + 23.4 kg; recipient height, 174.9 + 13.9 versus 168 + 25.1 cm; and TPG 12.1 + 7.2 versus 9.6 + 6.3 mmHg.</p><p><b>Conclusions:</b> The results show that HHT remains a feasible option in a highly selected patient population, with overall good results.</p>

Role of long-term continuous cardiac monitoring in oral anticoagulation management of patients with known atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Natale ◽  
SE Kasner ◽  
HC Diener ◽  
A Verma ◽  
A Amin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Risk Score ◽  
Oral Anticoagulation ◽  
Individual Risk ◽  
Private Company ◽  
Atrial Ablation ◽  
History Of ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic OnBehalf Reveal LINQ Registry Investigators Background Monitoring atrial fibrillation (AF) with an insertable cardiac monitor (ICM) provides objective data for clinicians to make decisions on oral anticoagulation (OAC) management, based on individual risk profiles. Whether ICM data is being used for that purpose has not been widely explored. Purpose To show the impact of AF burden measured by an ICM on OAC treatment initiation and discontinuation in patients with known AF. Methods Patients from the prospective, ongoing, multi-center Reveal LINQ Registry monitored for AF management, or pre- or post-ablation monitoring were eligible. Follow-up was scheduled every 6 months for up to 3 years. Patients were excluded if they had no AF data available within the last 6 months of follow-up (FU), or less than 6 months of FU and no change to their OAC treatment compared to baseline. AF burden was defined as the percentage of time in AF 6 months prior to last FU, excluding the first 3 months post-ablation for patients who had an ablation. Results The analysis included 225 patients (65 ± 10 years, 72% male, mean CHA2DS2-VASc score 2.1 ± 1.4) monitored with an ICM for 21.8 ± 7.9 months. At baseline, 164 (73%) were taking OAC therapy, 147 (65%) had a history of paroxysmal AF and 79 (35%) had persistent AF. Forty percent of patients had a history of atrial ablation prior to ICM insertion and 37% had ≥1 AF ablation procedure after ICM. Patients were grouped according to OAC status at baseline, CHA2DS2-VASc score and AF burden (Figure: bars show percentage of patients with a change in OAC status during monitoring). Patients at high risk of stroke and AF burden &gt;0.5% were more likely to initiate OAC therapy, whereas patients with higher AF burden were less likely to discontinue OAC, regardless of their risk score. Among those with no AF burden detected during the last 6 months of follow-up and on OAC at baseline, approximately half discontinued OAC, whereas 1/3 of patients with high risk score had initiated OAC, despite having no AF detected. Conclusion Our results derived from real-world practice show that AF detected and quantified by an ICM influences OAC therapy management in patients with known AF. Many patients with a low CHA2DS2-VASc score and no AF or low AF burden have had OAC therapy discontinuation, whereas a high proportion of patients with high AF burden have initiated OAC, regardless of their risk score. Abstract Figure. OAC according to risk and AF burden

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