Bradycardia and syncope as a presentation of cardiac allograft rejection involving the conducting system

Knight, Carrie S.; Tallaj, José A.; Rayburn, Barry K.; Pamboukian, Salpy V.; Bourge, Robert; Kirklin, James K.; McGiffin, David; Litovsky, Silvio H.

doi:10.1016/j.carpath.2008.10.006

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Volume 19, Issue 2 , Pages 117-120, March 2010

Bradycardia and syncope as a presentation of cardiac allograft rejection involving the conducting system

Carrie S. Knight
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
José A. Tallaj
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham VA Medical Center, Birmingham, AL, USA
- Corresponding author. THT 338, 1900 University Blvd, Birmingham, AL 35294, USA.
Barry K. Rayburn
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
Salpy V. Pamboukian
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
Robert Bourge
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
James K. Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
David McGiffin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
Silvio H. Litovsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA

Received 13 July 2008; received in revised form 16 September 2008; accepted 10 October 2008. published online 15 January 2009.

Abstract

Post-heart transplantation bradycardic syncope and arrest could be due to preferential rejection of the conduction system. We present six heart transplant patients with this presentation, two of whom died. The autopsy of one of those patients demonstrated severe rejection of the conduction system, with only mild rejection throughout the rest of the myocardium. We postulate that aggressive therapy for rejection and pacemaker placement may result in improved survival in heart transplant recipients with this clinical presentation.

Keywords: Bradycardia, Heart transplant, Rejection, Conducting system