Rufus Baretti, Birgit Debus, Bai-song Lin, Yu-Guo Weng, Miralem Pasic, Michael Hübler, Onnen Grauhan, Christoph Knosalla, Michael Dandel, Dagmar Kemper, Nicola Hiemann, Hans Brendan Lehmkuhl, Roland Hetzer
Deutsches Herzzentrum Berlin, Germany
[Applied Cardiopulmonary Pathophysiology 15: 256-271, 2011]
A variety of arrhythmias can occur after heart transplantation (HTx). Hearts selected to be donated for HTx should be in good condition and generally beat in sinus rhythm (SR). Absence or loss of SR after HTx can be due to any reason and can lead to serious hemodynamic problems. Ischemia reperfusion injury, unbalanced serum electrolytes and re-warming of cold myocardial tissue are known to initiate arrhythmia during the period of reperfusion after implantation of the heart graft. An important cause of arrhythmias after HTx is the possible rejection reaction, which often prompts supraventricular arrhythmias. Subsequent to the initial course after HTx operation transplant vasculopathy can cause arrhythmias of all kinds. The post-HTx effects of some antiarrhythmic substances such as amiodarone administered preoperatively are at present under discussion as possibly being associated with an increased risk for mortality.
A survey of patients’ data from the Deutsches Herzzentrum Berlin (DHZB) showed that continuous SR is accompanied by favorable course after HTx. Absence of SR or its loss predicts organ failure. Significant risk factors for cardiac graft failure were found to be associated with the preoperative condition of recipients and donors as well as with the operative procedures and the respective postoperative courses. Of these risk factors three were prominently associated with cardiac graft failure: absence or loss of SR initially after HTx operation, donor age over 30 years and previous thoracic operation of the recipient. Antiarrhythmic medication regulates cardiac rhythm. We examined the hypothesis whether preoperatively administered antiarrhythmic medication influences post-HTx cardiac rhythm and function due to loading of the recipient’s body with an antiarrhythmic substance. The examination of the DHZB data showed that medication for antiarrhythmic purposes in patients waiting for HTx is without influence on the occurrence or continuation of sinus rhythm or on the incidence of arrhythmia after HTx. No preoperatively administered antiarrhythmic substance was associated with postoperative arrhythmia or with cardiac graft failure.
Key words: heart transplantation, sinus rhythm, arrhythmia, cardiac graft failure, cardiac graft function, risk factor, medication, prognosis
Rufus Baretti, MD, PhD
Deutsches Herzzentrum Berlin
Augustenburger Platz 1