The electrophysiology of cardiac allograft rejection: Independent effects of rejection and perioperative ischemia on the sinus node recovery phenomenon after cardiac transplantation
We characterized the effect of cardiac allograft rejection on the sinus node (SN) recovery response from overdrive suppression. A total of 54 corresponding data sets (SN recovery time [SNRT]/endomyocardial biopsy [EMB]) was available in 24 transplant recipients with normal SNRT. Data were pooled in the rejection vs the no-rejection group (n=16 vs n=38, respectively).
During cardiac rejection (defined as a 7-day period starting 3 days prior to and lasting until 3 days after the EMB) the SNRT curves were moderately, but significantly shifted towards higher values (F=13.4, p=.0003). All changes occurred within accepted normal limits for the SNRT. Multivariate analysis indicated independent effects of donor heart ischemic time (p=.0005) on SNRT in addition to that of rejection. After accounting for that influence of ischemic time respective F values regarding the influence of rejection on the SNRT excursions were 10.8 (ischemic time<100 min, p=.0014) and 4.36 (ischemic time≥100 min, p=.039).
This study shows that cardiac allograft rejection significantly delays the SN recovery response from overdrive suppression. These changes, however, are subtle and, hence, are an unlikely explanation for the often grossly abnormal postoperative SN function.
Key wordsSinus noderecovery time rejection cardiactransplantation donorheartischemic time
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- 1.Sandhu JS, Uretsky BF, Zerbe TR, Goldsmith AS, Sudhakar R, Kormos RL, Griffith BP, Hardesty RL (1989) Coronary artery fistula in the heart transplant patient: a potential complication of endomyocardial biopsy. Circulation 79:350–356Google Scholar
- 2.Ellenbogen KA, Szentpetery S, Katz MR (1988) Reversibility of chronotropic dysfunction with theophylline following orthotopic heart transplantation. Am Heart J 116:202–206Google Scholar
- 3.Heinz G, Laufer G, Öhner T, Gasic S, Laczkovics A (1990) Analysis of heart rate changes in cardiac transplant recipients related to graft rejection. Am J Cardiol 66 (5):647–648Google Scholar
- 4.Sands KEF, Appel ML, Lilly LS, Schoen FJ, Mudge GH, Cohen RJ (1989) Power spectrum analysis of heart rate variability in human cardiac transplant recipients. Circulation 79:76–82Google Scholar
- 5.Zbilut JP, Murdock DK, Lawson L, Lawless CE, Von Dreele MM, Porges SW (1988) Use of power spectral analysis of respiratory sinus arrhythmia to detect graft rejection. J Heart Transplant 7:280–287Google Scholar
- 6.Bergfeld BL, Edhag KO, Solders G, Vallin HO (1987) Analysis of sinus cycle variation: a new method for evaluation of suspected sinus node dysfunction. Am Heart J 114:321–327Google Scholar
- 7.Heinz G, Öhner T, Laufer G. Laczkovics A (1990) Clinical and electrophysiologic correlates of sinus node dysfunction after orthotopic heart transplantation: Observations in 42 patients. Chest 97:890–95Google Scholar
- 8.Heinz G, Öhner T, Laufer G, Gössinger H, Gasic S, Laczkovics A (1991) Demographic and perioperative factors associated with initial and prolonged sinus node dysfunction after orthotopic heart transplantation: the impact of ischemic time. Transplantation 51 (6):1217–1232Google Scholar
- 9.Miyamoto Y, Curtiss E, Kormos RL, Armitage JM, Hardesty RL, Griffith BP (1990) Bradyarrhythmia after heart transplantation: incidence, time course and outcome. Circulation 82 (suppl IV):313–317Google Scholar
- 10.Jacquet L, Galal Z, Stein K, Griffith B, Armitage J, Hardesty R, Kormos R (1990) Cardiac rhythm disturbances early after orthotopic heart transplantation: prevalence and clinical importance of the observed abnormalities. J Am Coll Cardiol 16:832–7Google Scholar
- 11.Lower RR, Stofen RR, Shumway NE (1961) Homovital transplantation of the heart. J Thorac Cardiov Surg 41:196–202Google Scholar
- 12.Roberts AJ (1985) Myocardial protection in cardiac surgery. New York, Marcel Dekker, pp 101, pp 122Google Scholar
- 13.Laufer G, Laczkovics A, Wollenek G, Schreiner W, Kober I, Wolner E (1988) Incidence and severity of acute cardiac allograft rejection with two different low-dose cyclosporine maintainance protocols. Ann Thorac Surg 46:382–388Google Scholar
- 14.Laufer G, Laczkovics A, Wollenek G, Schreiner W, Wolner E (1981) Results of orthotopic heart transplantation with and without the use of maintainance steroids. Eur J Cardiothorac Surg 2 (4):237–43Google Scholar
- 15.Billingham ME (1981) Diagnosis of cardiac rejection by endomyocardial biopsy. J Heart Transplant 1:25–30Google Scholar
- 16.Murray KD, Howanitz EP (1987) Perioperative and postoperative management of the heart transplant patient. In: Myerowitz PD (ed) (1987) Heart transplantation. Futura, p 190Google Scholar
- 17.Mackintosh AF, Carmichael DJ, Wren C, Cory-Pearce R, English TAH (1982) Sinus Node function in the first three weeks after cardiac transplantation. Br Heart J 48:584–88Google Scholar
- 18.Bexton RS, Nathan AW, Hellestrand KJ, Cory-Pearce R, Spurrell RAJ, English TAH, Camm AJ (1984) Sinoatrial function after cardiac transplantation. J Am Coll Cardiol 3:712–23Google Scholar
- 19.Alboni P, Malcarne C, Pedroni P, Masoni A, Narula O (1982) Electrophysiology of normal sinus node with and without autonomic blockade. Circulation 65:1236–1242Google Scholar
- 20.Mandel W, Hayakawa H, Danzig R, Marcus HS (1971) Evaluation of sino-atrial node function in man by overdrive suppression. Circulation 44:59–66Google Scholar