Heart 1998;79:412-413 ( April )
Case report
Radiofrequency catheter ablation for atrial flutter following
orthotopic heart transplantation
Department of Cardiology and Cardiothoracic Surgery,
Queen Elizabeth Medical Centre, Edgbaston, Birmingham B15 2TH, UK
Correspondence to: Dr Pitt.
Accepted for publication 24 July 1997
A 26 year old woman with a diagnosis of limb girdle muscular
dystrophy and peripartum cardiomyopathy underwent orthotopic heart
transplantation using standard atrial anastomoses. Recurrent atrial
flutter was demonstrated in the absence of histological evidence of
cellular rejection. Radiofrequency ablation of the flutter circuit was
successfully performed allowing the avoidance of long term
antiarrhythmic therapy. Ten weeks following ablation and cessation of
amiodarone, presyncopal symptoms were found, associated with daytime
and nocturnal sinus pauses of 2.9 seconds and 4.2 seconds,
respectively. There was no evidence of AV node conduction impairment.
In view of the continued absence of cellular rejection and the evident
denervated state of the heart, the pauses reflected significant donor
sinus node dysfunction; therefore, an AAIR permanent pacing system was
implanted. At the time of pacemaker implantation atrial pacing at 150 beats/min did not produce significant PR interval prolongation or AV
block. This case serves to advise rigorous follow up in such patients
to continue to seek evidence of sinus node dysfunction potentially
requiring permanent pacemaker implantation.
© 1998 by Heart
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