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Vol. 73. Issue 2.
Pages 172 (February 2020)
ECG Contest
DOI: 10.1016/j.rec.2019.06.009
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Response to ECG, January 2020
Respuesta al ECG de enero de 2020
Raquel Luna-López, Tomás Datino
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Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Rev Esp Cardiol. 2020;73:8710.1016/j.rec.2019.06.008
Raquel Luna-López, Tomás Datino
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The correct answer is number 2: this is flutter of the native atrium, disconnected from the transplanted atrium after cardioversion in a female patient who had undergone a Shumway (biatrial) transplant. The graft also shows sinus dysfunction, with secondary nodal escape (Figure 1). These 2 findings, on their own, are common in transplant recipients,1 particularly following a biatrial technique.2

Figure 1

Diagnosis was confirmed with a temporary epicardial pacemaker (Figure 2). On atrial pacing at 90 bpm, graft atrial capture was achieved, thereby demonstrating that atrioventricular conduction is normal, and so answer 3 is incorrect. Capture also demonstrated that the flutter was derived from the native atrium because otherwise capture of the transplanted atrium could not be achieved at 90 bpm as the flutter has a higher frequency (answer 1 incorrect). In fact, the flutter continues to be dissociated from atrial pacing, as observed when pacing stopped (answer 4 incorrect).

Figure 2


D. Hamon, J. Taleski, V. Marmar, K. Shivkumar, N.G. Boyle.
Arrhythmias in the heart transplant patient.
Arrhythm Electrophysiol Rev., 3 (2014), pp. 149-155
S.C. Grant, M.A. Khan, E.B. Faragher, et al.
Atrial arrhythmias and pacing after orthotopic heart transplantation: bicaval versus standard atrial anastomosis.
Br Heart J., 74 (1995), pp. 149-153
Copyright © 2019. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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