RADIOFREQUENCY ABLATION OF A FASCICULAR TACHYCARDIA AFTER ORTHOTOPIC CARDIAC TRANSPLANTATION

A 51 year old male received an orthotopic transplant because of end st age ischaemic heart disease, The donor was a healthy male teenager wit h no history of arrhythmias or other cardiac conditions, The patient p resented with haemodynamically stable tachycardia and, dyspnoea five w eeks post-transplant, The ECG showed a regular tachycardia of 140 beat s/min with a right bundle branch block morphology, left axis deviation , and a QRS duration of 135 ms, There were independent P waves, captur e, and fusion beats confirming the diagnosis of ventricular tachycardi a. Endomyocardial biopsy showed moderate focal rejection that was thou ght to be responsible for the: arrhythmia. During the following six mo uths the patient had recurrent tachyarrhythmias; on each occasion the ECG morphology was the same and there was no cellular rejection. The p atient continued to have frequent hospital admissions with ventricular tachycardia requiring Dc cardioversion despite the empirical use of a miodarone, sotalol, disopyramide, and procainamide. Eighteen mouths af ter transplantation the diagnosis of fascicular tachycardia was suspec ted by ECG morphology and supported by successful termination with int ravenous verapamil, The arrhythmia was successfully managed by radiofr equency ablation. This patient shows that arrhythmias following transp lantation are not always related to rejection, and that other potentia lly reversible causes should be considered, particularly when the ECG during arrhythmia conforms to a classic configuration.