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

 Jin-Ho Kim  ;  Jaewon Oh  ;  Min Ji Kim  ;  In-Cheol Kim  ;  Jae-Sun Uhm  ;  Hui-Nam Pak  ;  Seok-Min Kang 
 YONSEI MEDICAL JOURNAL, Vol.60(5) : 423-428, 2019 
Journal Title
Issue Date
Adult ; Bundle-Branch Block/complications* ; Bundle-Branch Block/diagnostic imaging ; Bundle-Branch Block/physiopathology ; Cardiac Catheterization/adverse effects ; Echocardiography ; Electrocardiography ; Female ; Graft Rejection/diagnostic imaging ; Graft Rejection/etiology* ; Graft Rejection/immunology* ; Graft Rejection/physiopathology ; Heart Transplantation/adverse effects* ; Hemodynamics ; Humans ; Male
Right bundle branch block ; heart transplantation ; rejection
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Kim, Min-Ji(김민지)
Kim, Jin Ho(김진호)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Oh, Jae Won(오재원) ORCID logo https://orcid.org/0000-0002-4585-1488
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