HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grauhan, O. Articles by Hetzer, R. Search for Related Content PubMed PubMed Citation Articles by Grauhan, O. Articles by Hetzer, R.

European Journal of Cardio-Thoracic Surgery, Vol 7, 489-494, Copyright © 1993 by European Association for Cardio-thoracic Surgery

ARTICLES

Intramyocardial electrogram recordings for diagnosis and therapy monitoring of cardiac allograft rejection

O Grauhan, H Warnecke, J Muller, C Knosalla, T Cohnert, A Voss and R Hetzer
German Heart Institute, Berlin.

The registration of intramyocardial ECG amplitudes (IMEG) is a non- invasive diagnostic method of monitoring cardiac allograft rejection. In order to detect possible sources of error IMEG signals were recorded in heterotopic neck hearts in ten beagle dogs. Immunosuppression was based on cyclosporin A. The rejection process was followed by IMEG registrations as well as by serial myocardial biopsies. Intramyocardial electrogram recordings were made via three unipolar and three bipolar leads obtained from screw-in electrodes in both ventricles and the apex of the allograft. A 10% voltage drop was used as an indicator of rejection. In four dogs, the first rejection episode was treated with methyl-prednisolone and the therapy's success was monitored by IMEG and repeat biopsy. At autopsy the histology of each electrode circumference was correlated with the corresponding IMEG. The average sensitivity of a single lead was not acceptable (unipolar: 28%, bipolar: 47%). When the voltages of different leads were summed up the sensitivity rose to 43% (3 x unipolar), 85% (3 x bipolar) and 100% (all leads). During rejection therapy the IMEG recovered within 24-48 h. We conclude that in moderate allograft rejection (grade 2/3a ISHT classification), the rejection-related changes of intramyocardial ECG voltage amplitude (IMEG) seem to follow a "focal pattern" similar to the histology. Therefore the recording of several, preferably bipolar, electrode configurations appears to enhance adequate diagnostic reliability.

This article has been cited by other articles:

				J. E. Everett, M. N. Palmer, J. Jessurun, and S. J. Shumway Noninvasive Diagnosis of Cardiac Allograft Rejection in an Orthotopic Canine Model Ann. Thorac. Surg., November 1, 1996; 62(5): 1337 - 1340. [Abstract] [Full Text]

				J. Muller and R. Hetzer Invited Commentary Ann. Thorac. Surg., November 1, 1996; 62(5): 1340 - 1341. [Full Text]