Yonsei Med J.  2019 May;60(5):423-428. 10.3349/ymj.2019.60.5.423.

Association of Newly Developed Right Bundle Branch Block with Graft Rejection Following Heart Transplantation

• Kim JH
• Oh J
• Kim MJ
• Kim IC
• Uhm JS
• Pak HN
• Kang SM

• KMID: 2443245
• DOI: http://doi.org/10.3349/ymj.2019.60.5.423

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.

Keyword

Right bundle branch block; heart transplantation; rejection

MeSH Terms

Biopsy
Bundle-Branch Block*
Cardiac Catheterization
Cardiac Catheters
Echocardiography
Electrocardiography
Graft Rejection*
Heart Transplantation*
Heart*
Humans
Incidence
Transplants*

Figure

• 

  Fig. 1 Flow diagram of each group according to the development of RBBB after HT. HT, heart transplantation; RBBB, right bundle branch block.

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