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. 2021 Feb;35(2):e14165.
doi: 10.1111/ctr.14165. Epub 2020 Dec 6.

Radiofrequency ablation of supraventricular arrhythmias after orthotopic heart transplantation: Long-term follow-up of a single-center experience

María F Renedo  1 , José L González  2 , Gustavo A Giunta  1 , Elián F Giordanino  1 , Aldana S Ameri  1 , Mauricio A Mysuta  2 , Debora A Ramirez  2 , Liliana E Favaloro  1 , Roberto R Favaloro  1 , Daniel O Absi  1 , Néstor O Galizio  2 , Alejandro M Bertolotti  1
Affiliations

Radiofrequency ablation of supraventricular arrhythmias after orthotopic heart transplantation: Long-term follow-up of a single-center experience

María F Renedo et al. Clin Transplant. 2021 Feb.

Abstract

Background: Supraventricular arrhythmias (SVAs), commonly managed with radiofrequency ablation (RFA), may occur after orthotopic heart transplantation (OHT).

Methods: We retrospectively assessed 514 consecutive patients (pts.) undergoing OHT between January 1990 and July 2016 in a single-center. Patients with SVAs managed with RFA were included. Mechanisms of genesis of SVAs, association with surgical techniques and outcomes, were analyzed.

Results: Of 514 pts undergoing OHT, 53% (272 pts.) were managed with bicaval (BC) technique and 47% (242 pts.) with biatrial (BA) technique. Mean follow-up 10 ± 8.4 years. Nine pts. (1.7%) developed SVA requiring RFA. The BC technique was performed in 4 pts., 3 pts. presented cavotricuspid isthmus-dependent atrial flutter (CTI AFL), and 1 pt. double loop AFL. Five pts. were managed with BA technique, 4 pts. presented CTI AFL, and 1 pt. atrial tachycardia (AT). Mean time between OHT and SVA occurrence was 6.6 ± 5.5 years. The procedure was successful in 89% (8 pts.). Arrhythmia recurrence was seen in 3 pts (37%), all with BA technique.

Conclusion: Supraventricular arrhythmias in heart transplantation may be associated with the surgical scar. Identifying the mechanism is vital to choose the appropriate treatment with radiofrequency ablation.

Keywords: heart transplant; radiofrequency ablation; supraventricular arrhythmia.

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