Association of Newly Developed Right Bundle Branch Block with Graft Rejection Following Heart Transplantation
- Author(s)
- Jin-Ho Kim; Jaewon Oh; Min Ji Kim; In-Cheol Kim; Jae-Sun Uhm; Hui-Nam Pak; Seok-Min Kang
- Keimyung Author(s)
- Kim, In Cheol
- Department
- Dept. of Internal Medicine (내과학)
- Journal Title
- Yonsei Medical Journal
- Issued Date
- 2019
- Volume
- 60
- Issue
- 5
- Keyword
- Right bundle branch block; heart transplantation; rejection
- 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.
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