Atrial flutter: a possible early sign of acute rejection in heart transplantation. A case report
Boveda, S.; Galinier, M.; Lagrange, P.; Lagrange, A.; Cérène, A.; Delay, M.; Baccar, H.; Defaye, P.; Bounhoure, J.P.; Fauvel, J.M.
Archives des Maladies du Coeur et des Vaisseaux 94(6): 613-616
2001
ISSN/ISBN: 0003-9683 PMID: 11480160 Document Number: 536527
The authors report the case of a cardiac transplant patient with a recurrence of atrial flutter two months after electrical cardioversion and despite long-term preventive treatment with amiodarone. Early investigation for signs of rejection with 4 endomyocardial biopsies was negative. Aggravation of the haemodynamic status due to flutter with a rapid ventricular response led to an attempted radio-frequency ablation. Endocavitary mapping confirmed persistence of sinus activity in the native atrium and the presence of a circuit of type I isthmic flutter (anticlockwise circuit) in the donor atrium. Ablation by radio-frequency in the same procedure was successful. A fifth myocardial biopsy the same day finally confirmed stage 3A acute rejection. No signs of recurrent rejection or arrhythmia have been observed after 24 months' follow-up in this patient. This preliminary experience confirms the need to look for graft rejection by repeated myocardial biopsies in cardiac transplant, patients with atrial flutter and the efficacy of radio-frequency ablation in cases of resistance to conventional therapy.