Lost P’s, but Not Yet Forgotten

Abstract

A 30-year-old man presenting with 2 months of increasing cough and worsening dyspnea with minimal exertion was diagnosed with nonischemic dilated cardiomyopathy. An initial ECG revealed sinus tachycardia and left atrial enlargement. Despite maximal medical management, his symptoms and cardiac function did not improve. Orthotopic heart transplantation was performed using biatrial anastomosis from a 27-year-old donor. In this procedure, the donor atria are sutured to intact remnants of the native right and left atria, allowing for minimal interruption of blood flow from both vena cavae and all the recipient’s pulmonary veins while requiring fewer anastomotic connections. The recipient’s native right and left atrial remnants are physically and electrically intact and are sutured into and electrically isolated from the donor atria. A postoperative ECG was performed (Figure 1), revealing …