INDUCIBLE ATRIAL-FLUTTER AND FIBRILLATION AFTER ORTHOTOPIC HEART-TRANSPLANTATION

Inducible atrial flutter (two patients) and fibrillation (two patients ) were observed in a series of 35 heart transplant patients who underw ent evaluation of sinus node function including premature atrial stimu lation. The sinus node function was entirely normal in both patients w ith inducible atrial flutter. In contrast it was profoundly abnormal i n the patients with inducible atrial fibrillation. Atrial fibrillation was no longer inducible as the sinus node function became borderline normal. These observations suggest extensive electrical atrial abnorma lity, including the sinus node, in patients with atrial fibrillation, and temporary pacing should be available when considering cardioversio n in patients with atrial fibrillation early after heart transplantati on. Atrial flutter, in contrast, may be inducible in the absence of an y sinus node abnormality and without any evidence of rejection.