Elsevier

Transplantation Proceedings

Volume 39, Issue 10, December 2007, Pages 3303-3305
Transplantation Proceedings

Thoracic transplantation
Outcome
Lessons Learned With Noninvasive Cardiac Monitoring for Acute Rejection

https://doi.org/10.1016/j.transproceed.2007.09.005Get rights and content

Abstract

Introduction

Computerized Heart Allograft Rejection Monitoring (CHARM), used for noninvasive rejection monitoring in heart transplant recipients, is based on the analysis of ventricular evoked response (VER) signals. This study evaluated the prognostic validity of the TslewC, a parameter extrapolated from the VER.

Methods

During orthotopic heart transplantation (OHT) 2 unipolar, fractally coated, screw-in leads implanted epimyocardially were connected to a telemetric pacemaker. Recordings of IEGMs were performed routinely at hospital and at outpatient visits. Data processing yielded trend curves. TslewC was calculated from the tangent of VER. One hundred five patients divided into survivors and nonsurvivors, were compared using a two-tailed Student’s t test.

Results

In the final follow-up a significant lower TslewC was observed among patients in the nonsurvivor compared with the other group (P < .001). Tests to find an optimal prognostic threshold of the TslewC yielded the value of 26 mV.

Conclusion

TslewC functioned as a prognostic factor after OHT. Further studies must provide a prognostic threshold to avoid patient visits all 4 weeks. Patients would only have to be admitted to the hospital if the TslewC was under this prognostic threshold.

Section snippets

Methods

Computerized Heart Allograft Rejection Monitoring (CHARM) evaluates parts of the ventricular evoked response (VER; Fig 1).

OHT was performed using the standard technique on recipients who received induction therapy with antithymocyte globulin followed by cyclosporine, azathioprine, or mycophenolate mofetil and aprednisolone.

During OHT 2 unipolar, fractally coated, screw-in leads (ELC 54-UP, Biotronik, Berlin, Germany) were implanted epimyocardially: one into the left ventricle lateral wall and a

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