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Theefficacyofelectrocardiographyin detectingacuterejectioninpediatricheart transplantrecipients ¡ Acuteallograftrejectionisanimportant problemforhearttransplantrecipients. ¡ Endomyocardialbiopsyisthemostreliable butinvasivemethodtodetectacute rejection. ¡ WeaimedtodetectefficacyofECGtohelp diagnosisofacuterejection. ¡ 37patientsundergoingorthotopicheart transplantationbetween2005-2016are included. ¡ Data § Presenceofrejectioninthebiopsies § Echocardiographyresultsand § ECGrecordingsduringadmissionforbiopsyand onsuspicionforrejectionareevaluated. ¡ ECGdata § PR,QRS,QTcperiod § QRSaxis § Heartrate § STsegmentandTwaveabnormalities § Ventricularhypertrophy § Conductionblock § Voltagesuppresion,and § Dysrhythmiawerenoted. ¡ Meanageatthetimeoftransplantationwas 11.9y(11months-19years). ¡ Cardiacdiagnoses § dilatedcardiomyopathy § restrictivecardiomyopathy § congenitalheartdisease § chemotherapy-relatedcardiomyopathy § hypertrophiccardiomyopathy § arrhythmogenicrightventriculardysplasia 15 12 4 2 1 1 ¡ Figure.Distributionof252biopsiesscoredbytheInternational SocietyforHeartandLungTransplantation(ISHLT)guidelines [Stewart2005].Grade0R=norejection;grade1R=mild;grade2R= moderate;grade3R=severerejection. Norejec(on Grade1R Grade2R Acutehumoral S u s p e c t e d humoral PR(msec) QRS(msec) QTc(msec) Heartrate (beat/min) 142.7 73.2 420.6 99.5 130.7 146.6 130.8 145.2 (p:0.117) (p:0.60) (p:0.05) (p:0.68) 64.1 51.6 72.4 64.7 (p:0.05) (p:0.016) (p:0.90) (p:0.24) 426.3 417 423.8 435.5 (p:0.38) (p:0.76) (p:0.74) (p:0.14) 108.1 110 113.8 104.2 (p:0.03) (p:0.14) (p:0.18) (p:0.42) ST STdepression eleva(on VHT Arrythmia Twave suppression N(%) N(%) N(%) N(%) N(%) N(%) 2mm 1mm 2mm N(%) N(%) N(%) N(%) 2 10 4 29 2 8 (5) (2) (14.4) (1) (43.6) (2.5) (6.5) (3) 3 13 2 1 (4.2) (37.5) (2.1) (8.4) (2) (4.5) (1) Rejec(on 2 (+) LBBB 1mm Rejec(on 9 (-) N e g a ( v e V o l t a g e RBBB 1 12 (4.2) (2.1) (25) p:0.034 (6.3) (27.1)* 8 5 8 1 1 4 3 6 1 ¡ Ventricularand supraventricular tachycardia Routinefollow-upvisit Nocomplaint Tachycardiaandpretibialedema Echo:Ejectionfraction31%,shoteningfraction 16% ¡ ECG:voltagesuppresion ¡ Headmittedthathedidnottakemedications last2weeks ¡ At6thdayoftreatment,biopsyshowedno rejectionalthoughechoandECGwerestill abnormal ¡ ¡ ¡ ¡ Ejectionfraction31%,shoteningfraction16% The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. § Themostprevalentabnormality:completeor incompleteRBBB.NewRBBBappearedin69%ofthe patients,mainlyduringthefirstmonth. § 9episodesofsupraventriculararrhythmias:1atrial fibrillation,6atrialflutter,1junctionaltachycardia § 3ofthe6episodesofatrialflutteroccurredduringan episodeofacuterejection § RBBBwasnotassociatedwithacuterejection Clin. Cardiol. 21, 680-684 (1998) Presentation with sinus tachycardia and lateral ST-segment elevations with reciprocal depressions in inferior leads . Circ Heart Fail. 2015;8:836-838 On hospital day #5 ECG demonstrating resolved ST-segment elevations Circ Heart Fail. 2015;8:836-838 ¡ RoutineECGfollow-upofpatientswithOHT waspreviouslyshowntohelpdetectacute rejection. ¡ OurstudysupportsthepowerofECGto demonstrateabnormalitiesevenin asymptomaticpatientsandinthosewith normalbiopsybutwithclinicalevidenceof acuterejection. ¡ SerialECGsareimportanttodepict deteriorations ¡ STdepressionorelevation ¡ Twaveinversion ¡ Voltagesuppression ¡ Newonsetarrythmiaespeciallyafterthefirst 3monthsshouldalertforacuterejection