Association of Newly Developed Right Bundle Branch Block with Graft Rejection Following Heart Transplantation
10.3349/ymj.2019.60.5.423
- Author:
Jin Ho KIM
1
;
Jaewon OH
;
Min Ji KIM
;
In Cheol KIM
;
Jae Sun UHM
;
Hui Nam PAK
;
Seok Min KANG
Author Information
1. Division of Cardiology, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea. smkang@yuhs.ac
- Publication Type:Original Article
- Keywords:
Right bundle branch block;
heart transplantation;
rejection
- MeSH:
Biopsy;
Bundle-Branch Block;
Cardiac Catheterization;
Cardiac Catheters;
Echocardiography;
Electrocardiography;
Graft Rejection;
Heart Transplantation;
Heart;
Humans;
Incidence;
Transplants
- From:Yonsei Medical Journal
2019;60(5):423-428
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: We aimed to examine associations between right bundle branch block (RBBB) following heart transplantation (HT) and graft rejection. MATERIALS AND METHODS: We investigated 51 patients who underwent endomyocardial biopsies, electrocardiogram, right-side cardiac catheterization, and echocardiography at 1 month and 1 year after HT. We classified patients into four groups according to the development of RBBB, based on electrocardiogram at 1 month and 1 year: 1) sustained RBBB, 2) disappeared RBBB, 3) newly developed RBBB, and 4) sustained non-RBBB. The RBBB was defined as an RSR' pattern in V1 with a QRS duration ≥100 ms on electrocardiogram. RESULTS: The newly developed RBBB group (n=13, 25.5%) had a higher rate of new onset graft rejection (from grade 0 to grade ≥1R, 30.8% vs. 10.0% vs. 21.4%, p=0.042) at 1 year, compared with sustained RBBB (n=10, 19.6%) and sustained non-RBBB group (n=28, 54.9%). In contrast, the incidence of resolved graft rejection (from grade ≥1R to grade 0) was higher in the sustained RBBB group than the newly developed RBBB and sustained non-RBBB groups (70.0% vs. 7.7% vs. 25.0%, p=0.042). Left atrial volume index was significantly higher in the newly developed RBBB group than the sustained RBBB and sustained non-RBBB groups (60.6±25.9 mL/m2 vs. 36.0±11.0 mL/m2 vs. 38.4±18.1 mL/m2, p=0.003). CONCLUSION: Close monitoring for new development of RBBB at 1 year after HT, which was associated with a higher incidence of new onset graft rejection, may be helpful to identify high risk patients for graft rejection.
