14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-214

Heart graft recipient monitoring using telemetrically recorded ventricular evoked response

Véronique Mahaux, Jean Claude Demoulin, Guenter Schreier*, Raymond Limet, Henri Kulbertus.
University of Liege, Belgium, *University of Graz, Austria

Introduction

Although the survival of heart transplant recipients markedly improved since the introduction of cyclosporin A, early detection of rejection episodes remains a major challenge. Indeed, patients usually remain asymptomatic until a significant myocardial damage results in heart failure. Endomyocardial biopsy, gold standard of rejection monitoring is invasive, expensive and only provides snapshots of the graft status, while the immunologic balance between recipients and allograft is continuously on-going. Those limitations have spurred the search for reliable, non invasive and easily repeated monitoring rejection tools.

Different electrocardiographic parameters including RR variability^1,2 and signal averaged ECG^3,4 were successively proposed as alternative follow-up tools with unsatisfactory results in terms of sensitivity.

Electrophysiologic analysis progressively focused of the repolarization phase of the paced QRS. Indeed, ionic abnormalities due to cell necrosis, and alterations of transmembranic ionic transportation could alter repolarization. In-depth analysis of the evoked T wave disclosed the potential interest of monitoring the maximum slew rate of the T wave repolarization phase⁵.

The purpose of our study was to evaluate the clinical usefulness of extracting this parameter from telemetrically recorded paced ventricular electrograms in the detection of grade 3 or higher acute cardiac allograft rejection.