Mechanism of Typical Atrial Flutter in a Patient After Cardiac Transplant: Functional Slowing From Geometric Distortion.

Q4 Medicine

JACC. Case reports Pub Date : 2025-09-25 DOI:10.1016/j.jaccas.2025.105487

Alejandro Plana, Jeremy S Treger, Jonathan Grinstein, Mark Belkin, Valluvan Jeevanandam, Gaurav A Upadhyay

{"title":"Mechanism of Typical Atrial Flutter in a Patient After Cardiac Transplant: Functional Slowing From Geometric Distortion.","authors":"Alejandro Plana, Jeremy S Treger, Jonathan Grinstein, Mark Belkin, Valluvan Jeevanandam, Gaurav A Upadhyay","doi":"10.1016/j.jaccas.2025.105487","DOIUrl":null,"url":null,"abstract":"Background: Atrial flutter and atrial fibrillation occur after orthotopic heart transplant (OHT) in 25% of patients. Hemodynamic and medication restrictions in this unique population limit treatment.Case summary: A patient experienced prolonged episodes of paroxysmal atrial flutter and hypotension 8 days after OHT. Electrophysiology study demonstrated typical cavotricuspid isthmus (CTI)-dependent flutter, with slowing at the CTI midportion. Intracardiac echocardiography revealed that this site was distant from any suture lines or anastomoses. The slowing appeared to be secondary to geometric distortion (ie, \"buckling\" of the atrial wall) of the CTI.Discussion: Typical atrial flutter caused by functional slowing from structural distortion is distinct from prior reports of atrial flutter attributed to conduction block from suture lines. Computational models support the hypothesis that tissue curvature changes can lead to altered atrial conduction properties.Take-home message: Functional slowing from geometric distortion should be considered as a cause of atrial flutter in the post-OHT setting.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"105487"},"PeriodicalIF":0.0000,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Case reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.jaccas.2025.105487","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Atrial flutter and atrial fibrillation occur after orthotopic heart transplant (OHT) in 25% of patients. Hemodynamic and medication restrictions in this unique population limit treatment.

Case summary: A patient experienced prolonged episodes of paroxysmal atrial flutter and hypotension 8 days after OHT. Electrophysiology study demonstrated typical cavotricuspid isthmus (CTI)-dependent flutter, with slowing at the CTI midportion. Intracardiac echocardiography revealed that this site was distant from any suture lines or anastomoses. The slowing appeared to be secondary to geometric distortion (ie, "buckling" of the atrial wall) of the CTI.

Discussion: Typical atrial flutter caused by functional slowing from structural distortion is distinct from prior reports of atrial flutter attributed to conduction block from suture lines. Computational models support the hypothesis that tissue curvature changes can lead to altered atrial conduction properties.

Take-home message: Functional slowing from geometric distortion should be considered as a cause of atrial flutter in the post-OHT setting.

查看原文本刊更多论文

心脏移植后典型心房扑动的机制：由几何畸变引起的功能减慢。

背景：25%的患者在原位心脏移植（OHT）后发生心房扑动和心房颤动。血液动力学和药物限制在这个独特的人群限制治疗。病例总结：1例患者在OHT后8天出现阵发性心房扑动和低血压。电生理研究显示典型的颈三尖瓣峡部（CTI）依赖性颤振，在CTI中部减慢。心内超声心动图显示该部位远离任何缝合线或吻合口。减缓似乎是继发于CTI的几何畸变（即心房壁的“屈曲”）。讨论：典型的心房扑动是由结构畸变引起的功能减慢引起的，与先前报道的由缝合线传导阻滞引起的心房扑动不同。计算模型支持组织曲率改变可导致心房传导特性改变的假设。关键信息：几何畸变引起的功能减慢应被认为是oht后心房扑动的一个原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊