Mark F A Bierhuizen, Hongxian Xiang, Mathijs van Schie, Jorik H Amesz, Sanne J J Langmuur, Paul Knops, Olivier C Manintveld, Jolanda Kluin, Yannick J H J Taverne, Natasja M S de Groot
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引用次数: 0
Abstract
Background: Donation after circulatory death (DCD) hearts undergo warm and cold ischemia before transplantation. Atrial ischemia is an important contributor to the development of electrophysiological abnormalities and post-transplantation atrial arrhythmias. The purpose of this study was to characterize atrial electrophysiological properties of DCD hearts during normothermic ex-situ heart perfusion (ESHP), and to report post-transplantation incidence of atrial tachyarrhythmias, sinus node dysfunction (SND) and atrioventricular block (AVB).
Methods: High-resolution epicardial mapping was performed in 23 human DCD hearts during ESHP and compared to a control group consisting of 15 patients undergoing intra-operative epicardial mapping during coronary artery bypass surgery. Unipolar potential voltages and potential types (single, short double, long double, and complex potentials), conduction velocity (CV), continuous conduction delay, and block (cCDCB) lines were quantified in the right atrium (RA), including the sinoatrial node (SAN) exit site, Bachmann's bundle (BB), and the left atrium (LA). The occurrence of post-transplantation atrial tachyarrhythmias, SND, and AVB was evaluated.
Results: The atria of DCD hearts were characterized by lower median potential voltages and a higher proportion of low-voltage areas, fractionation, and areas of slow and heterogeneous conduction. Atrial tachyarrhythmias (57%), SND (9%), and AVB (13%) were prevalent in DCD hearts after transplantation. Patients with post-transplantation AVB had significantly longer functional warm ischemic times (FWIT) (24 vs 18 minutes, p = 0.002) and first cold ischemic times (CIT-1) (43 [35-43] vs 34 [31-35] minutes, p = 0.033), whereas patients with AF had significantly longer second cold ischemic times (CIT-2) (103 vs 80 minutes, p = 0.038).
Conclusion: During ESHP, atrial electrophysiological properties of the DCD hearts are characterized by abnormal electrical signal morphologies and conduction abnormalities. Post-transplantation arrhythmias are prevalent and are associated with ischemia duration during the transplantation procedure.
Translational perspective: DCD hearts show atrial electrical abnormalities during normothermic ex-situ heart perfusion, reflecting ischemic injury that may predispose recipients to early post-transplant arrhythmias. Electrical abnormalities at the sinoatrial node activation site and in atrioventricular conduction are detectable before transplantation and may be associated with post-transplant sinus node dysfunction and atrioventricular block. After transplantation, atrial fibrillation and atrial flutter occur frequently. These findings support intensified perioperative rhythm surveillance, consideration of early pacing strategies, and efforts to minimize ischemic time to improve rhythm outcomes after DCD heart transplantation.
背景：循环死亡（DCD）后的心脏捐献在移植前经历了热缺血和冷缺血。心房缺血是导致移植后电生理异常和心房心律失常的重要因素。本研究的目的是表征DCD心脏在常温离体心脏灌注（ESHP）期间的心房电生理特性，并报告移植后心房速性心律失常、窦房结功能障碍（SND）和房室传导阻滞（AVB）的发生率。方法：在ESHP期间对23例DCD心脏进行高分辨率心外膜测绘，并与冠状动脉搭桥术中进行术中心外膜测绘的15例患者组成的对照组进行比较。定量右心房（RA）包括窦房结（SAN）出口部位、巴赫曼束（BB）和左心房（LA）的单极电位电压和电位类型（单、短双、长双和复电位）、传导速度（CV）、连续传导延迟和传导阻滞（cCDCB）线。观察移植后心房心动过速、SND、AVB的发生情况。结果：DCD心脏心房电位中位电压较低，低压区、分流区和缓慢非均匀传导区比例较高。房性心动过速（57%）、SND（9%）和AVB（13%）在DCD心脏移植后普遍存在。移植后AVB患者的功能热缺血时间（FWIT） （24 vs. 18 min, p = 0.002）和首次冷缺血时间（CIT-1） （43 [35-43] vs. 34 [31-35] min, p = 0.033）显著延长，而AF患者的第二次冷缺血时间（CIT-2）显著延长（103 vs. 80 min, p = 0.038）。结论：在ESHP过程中，DCD心脏心房电生理特性表现为电信号形态异常和传导异常。移植后心律失常是普遍存在的，并且与移植过程中的缺血时间有关。平移角度：DCD心脏在常温离体心脏灌注时显示心房电异常，反映了缺血损伤，可能使受者易发生移植后早期心律失常。窦房结激活部位和房室传导的电异常在移植前可检测到，可能与移植后窦房结功能障碍和房室传导阻滞有关。移植后房颤和心房扑动频繁发生。这些发现支持加强围手术期心律监测，考虑早期起搏策略，并努力减少缺血时间以改善DCD心脏移植后的心律结果。
期刊介绍：
The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.
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