PALPITATIONS AND CARDIAC AWARENESS AFTER HEART-TRANSPLANTATION

Objective: The aim of this study was to examine the awareness of resti ng heartbeat in heart transplantation recipients, compare it with that found in other medical populations, and determine whether clinical ch aracteristics are associated with accurate heartbeat awareness. Method s: Eligible patients underwent a research battery consisting of a hear tbeat detection task and self-report questionnaires assessing cardiac symptoms, psychosocial variables, and cognitive function. The accurate awareness of resting heartbeat was determined by presenting the patie nts with auditory stimuli at each of six different delays following th e R wave on the EGG. Patients then selected the tones that they though t coincided with the sensation they had of their heart beating. The pa tients' physicians rated their cardiac morbidity. The results were con trasted with comparable data obtained in previous work with other ambu latory medical populations. Results: Forty-one consecutive heart trans plantation recipients who survived for at least 3 months after surgery were eligible. Thirty-four (82.9%) of them were studied and complete data were obtained on 26 (63.4%). Nine patients (34.6%) were reliably able to detect their resting heartbeat. When compared with the 17 pati ents who were not accurately aware of their heartbeat, the two groups did not differ significantly in cardiac morbidity, cognitive brain dys function, generalized psychiatric distress, depression, somatization, or hypochondriacal attitudes. A significantly higher proportion of hea rt transplantation recipients were accurately aware of their heartbeat than was found in a sample of general medical outpatients and in asym ptomatic, nonpatient volunteers. Conclusions: One-third of heart trans plant recipients are accurately aware of resting heartbeat, despite th e absence of cardiac innervation.