Abstract
BackgroundDifferent atrial arrhythmias can coexist in the recipient and donor atria after heart transplantation.Case presentationWe report an unusual case of a patient with three different types of atrial arrhythmia after heart transplantation: an atrial fibrillation in the recipient atria, and a cavotricuspid isthmus dependent atrial flutter and a focal atrial tachycardia in the donor atria. 3D electroanatomical mapping and ablation were guided by remote magnetic navigation (RMN). Atrial fibrillation continued in the recipient atria even after the donor heart was converted to sinus rhythm by ablation.ConclusionsIt is critical to understand the surgical anatomy of a bi-atrial anastomosis and its relevant electrical activation pattern before ablation. Appropriate electroanatomical mapping strategy with RMN can facilitate the successful ablation of post-transplant atrial arrhythmias.
Highlights
Different atrial arrhythmias can coexist in the recipient and donor atria after heart transplantation
Better understanding of the surgical anatomy of a bi-atrial anastomosis and the electrical activation patterns by 3D electroanatomical mapping allowed us to identify the mechanisms of different atrial arrhythmias, and approach their successful ablation [5]
We reported an unusual case of a patient with three different types of atrial arrhythmia after heart transplantation: an atrial fibrillation (Af ) in the recipient atria, and a cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) and a focal atrial tachycardia (AT) in the donor atria
Summary
The incidence of atrial arrhythmias after heart transplantation has been decreasing in the past decades, it has still ranged from 10 to 20 % in recent studies [1, 2]. Different supraventricular rhythms can coexist in the recipient atria and donor atria [3,4,5]. We reported an unusual case of a patient with three different types of atrial arrhythmia after heart transplantation: an atrial fibrillation (Af ) in the recipient atria, and a cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) and a focal atrial tachycardia (AT) in the donor atria. Case presentation A 65-year-old man underwent orthotopic heart transplantation with bi-atrial anastomosis due to dilated cardiomyopathy in 1995. The patient developed symptomatic persistent AFL that was refractory to anti-
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