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Case Reports
. 2011 Jul;16(3):308-10.
doi: 10.1111/j.1542-474X.2011.00433.x.

P-wave rejection in a transplanted heart

Christopher M Lowery  1 , Laurent Lewkowiez, William H Sauer
Affiliations
Case Reports

P-wave rejection in a transplanted heart

Christopher M Lowery et al. Ann Noninvasive Electrocardiol. 2011 Jul.

Abstract

Background: Heart block can occur at multiple levels in patients with prior cardiac transplant. This diagnosis is usually ascertained using the surface electrocardiogram.

Results: A 24-year-old man with prior cardiac transplant presented with apparent complete atrioventricular nodal block and junctional escape on the surface ECG. During pacemaker implantation, we demonstrated sinus rhythm in the recipient atrium, block across the atrioatrial anastomosis, and sinus arrest with intact AV nodal conduction in the donor atrium.

Conclusion: This case illustrates an unusual presentation of sinus arrest occurring 2 years after heart transplantation that appeared to be complete heart block.

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Figures

Figure 1
Figure 1
Electrocardiogram at baseline demonstrating intact AV conduction.
Figure 2
Figure 2
Electrocardiogram demonstrating apparent complete AV nodal block.
Figure 3
Figure 3
Electrocardiogram demonstrating atrial pacing, ventricular tracking, and dissociated P waves.
See this image and copyright information in PMC

References

    1. Marcus GM, Hoang KL, Hunt SA, et al Prevalence, patterns of development, and prognosis of right bundle branch block in heart transplant recipients. Am J Cardiol 2006;98:1288–1290. - PubMed
    1. Cooper JA, Saeed IM, Moazami N, et al Lost P's, but not yet forgotten. Circulation 2007;115:e41–e42. - PubMed
    1. Cui G, Kobashigawa J, Margarian A, et al Causes of atrioventricular block after heart transplantation. Transplantation 2003;76:137–142. - PubMed

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