RT-214
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Heart graft recipient monitoring using telemetrically recorded ventricular evoked response
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Véronique Mahaux, Jean Claude Demoulin, Guenter Schreier*, Raymond Limet, Henri Kulbertus.
University of Liege, Belgium,
*University of Graz, Austria
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Abstract
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The monitoring of the ventricular evoked response through high
resolution pacemaker telemetry was proposed as a noninvasive diagnostic tool during the follow-up of heart
transplant recipients. The variations of the negative slew rate of the evoked T wave were compared to the results
of endomyocardial biopsy in the diagnosis of clinically significant acute rejection episodes. Paced unipolar
ventricular electrograms were recorded in 11 heart transplant recipients after each biopsy. The signals were
digitized on a laptop-based computer and transferred via Internet to the central processing site where the
Rejection Sensitive Parameter (RSP) was extracted. Clinical patient management was blinded to the electrogram
results during the first six months post implantation. The application of a single-threshold diagnosis model to the
RSP value allowed the detection of grade 3 rejection episodes with 100% sensitivity, 77% specificity, 100%
negative predictive value and 35% positive predictive value. Using RSP as an easily repeated, noninvasive follow
up tool of heart transplant recipients, the number of endomyocardial biopsy might be markedly reduced (69%),
leading to a potential positive cost/effectiveness analysis.
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Key Words
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