Arrhythmias in pediatric heart transplant recipients: Prevalence and association with death, coronary artery disease, and rejection

To ascertain the prevalence and types of arrhythmias occurring after heart transplantation in children, all available 24-hour ambulatory ECGs (mean, 1.5/patient), and 12-lead surface ECGs (mean, 27/patient) obtained from 59 orthotopic pediatric heart transplant recipients (mean age, 9.7 ± 5.9 years) were examined. Correlation of the appearance of arrhythmias with the occurrence of rejection, coronary artery disease, or death was investigated. Of the 59 patients, 24 (41%) were found to have arrhythmias including chronic sinus tachycardia (eight patients), sinus bradycardia (four patients), supraventricular tachyarrhythmias (nine patients), significant ventricular premature depolarizations (seven patients), and nonsustained ventricular tachyarrhythmias (seven patients). The occurrence of arrhythmias was not significantly associated with the number of rejections per patient month of survival. However, a significant proportion of patients with supraventricular (seven of nine patients; p = 0.006) and ventricular (six of seven patients; p = 0.02) tachyarrhythmias experienced a rejection episode in association with the onset of the rhythm abnormality. The presence of coronary artery disease was significantly associated with the presence of ventricular tachyarrhythmias (p = 0.03). Graft survival was significantly lower in those patients with arrhythmias as compared with the arrhythmia-free group (58% versus 86%, p = 0.02). The results suggest that the appearance of arrhythmias in a pediatric heart transplant recipient should prompt a search for the presence of rejection and/or coronary artery disease.