Two concomitant arrhythmias in a transplanted heart

Excerpt

A 61-year-old man was admitted to our center complaining from palpitations due to frequent supraventricular extrasystoles (SVES). The patient had received an orthotopic heart-transplantation in 1989 due to dilated cardiomyopathy. In 2005, isthmus-dependent typical atrial flutter was documented and successfully ablated. Before the current admission, a 3-day Holter ECG recording was done which showed 15,000 SVES per day. There had been no signs of rejection and the left ventricular ejection fraction was 65%. On the 12-lead surface ECG a sinus rhythm with frequent SVES was noted with a P wave morphology closely resembling the sinus rhythm. Since the patient was highly symptomatic, we decided to perform an invasive electrophysiological study and ablation [1‐3]. …