Patient 47 y.o after three myocardial infarction and left ventricle aneurism was admitted to Federal Center for Cardiovascular Surgery with severe heart failure. He had low ejection fraction (27%) and severe mitral and tricuspid valve regurgitation. Coronary angiography revealed multiple severe stenosis of both coronary arteries. Clinical decision was to perform heart transplantation. One month later orthotopic heart transplantation was performed in this patient. No signs of heart rejection were found on endomyocardial biopsy. Five months later patient had complaints on palpitations. Holter monitoring revealed 22809 premature atrial contractions and non-sustained runs of supraventricular tachycardias. Two antiarrhythmic drugs I and III class were ineffective. Catheter radiofrequency ablation was chosen as an option for arrhythmia treatment. Patient was taken to Cath lab. 3D navigation system NavX and high-density mapping catheter HD Greed (Abbott laboratories, USA) were used for substrate mapping. The source of arrhythmia was localized in right superior pulmonary vein of recipient. Ectopic beat was propagated from recipient pulmonary vein on donor atrium was via surgical suture (picture 1). Two ablation strategy were analysed: 1) To ablate the area of ectopic foci, 2) To ablate the area of propagation in surgical suture – Electrically isolate donor and recipient atria by scar formation. Decision was taken is to electrically isolate two atria. Couple of RF application was applied in the area of interatrial propagation in surgical suture. Normal sinus rhythm was restored after catheter ablation, but ectopic foci from PV was still firing. (Picture 2). There were only artifacts on surface ECG created by ectopic beats of recipient’s pulmonary veins. Holter monitoring in 3,6,9,12 months of follow up didn’t reveal recurrence of arrhythmia.

TBA...