ATRIAL ARRHYTHMIAS AND PACING AFTER ORTHOTOPIC HEART-TRANSPLANTATION - BICAVAL VERSUS STANDARD ATRIAL ANASTOMOSIS

Background-Right and left atrial configuration is more normal when the donor left atrium is anastomosed to a recipient left atrial cuff with direct anastomoses of the donor and recipient vena cavas on the right side. The right atrium and sinus node may be less disturbed by the te chnique of bicaval anastomosis than by the standard procedure. Objecti ve-To compare the incidence of atrial arrhythmias and pacing after bic aval and standard anastomoses. Methods-75 patients had heart transplan ts between January 1991 and December 1993. The notes were reviewed. Ni ne patients who died within the first 30 days were excluded from furth er analysis (seven patients with standard anastomoses, one with bicava l anastomosis, and one with a hybrid technique). Results-66 patients s urvived for more than 30 days. Thirty five patients had standard anast omoses and 31 bicaval anastomoses. Atrial tachyarrhythmias (atrial fib rillation, atrial flutter, atrial tachycardia, or supraventricular tac hycardia) occurred on four days in three patients in the bicaval group compared with 27 days in 13 patients in the standard group (P = 0.009 ). The relative risk of atrial tachyarrhythmias with standard anastomo sis was 5.52 (P = 0.015) compared with that of bicaval anastomosis. At rial tachyarrhythmias requiring treatment occurred less often in the b icaval group (four episodes in three patients in the bicaval group and eight episodes in four patients in the standard group), and fewer pat ients with a bicaval anastomosis required temporary pacing (pacing on 20 days in 10 patients in the bicaval group, but pacing on 49 days in 16 patients in the standard group) and late permanent pacing (no patie nts in the bicaval group and three patients in the standard group), al though these differences were not statistically significant. Patients in the bicaval group were discharged from hospital sooner than those i n the standard group (mean 24.1 v 29.1 days, P = 0.024). Conclusions-T he technique of bicaval anastomosis, in addition to theoretical advant ages from maintaining a more normal atrial configuration, has a lower incidence of postoperative atrial tachyarrhythmias, may reduce the nee d for pacing, and allows earlier discharge from hospital.