Malignant ventricular arrhythmia in a heart transplant patient

: The authors describe a case of a 48-year old man living more than 9 years with a transplanted heart. Beside chronic complications (repeated rejection, gradual progression of renal and hepatic insufficiency, osteoporosis, marrow suppression), deterioration of cardiac insufficiency and angiographically documented coronary disease of the graft, there appeared haemodynamically severe persisting ventricular tachycardias degenerating into ventricular fibrillation. Frequent exacerbation of tachyarrhythmias despite the applied antiarrhythmic drugs (mexiletine, amiodarone) which were only partially effective, required repeated electrical cardioversions/defibrillations (totally 16 times). The patient in the clinical state of multi-organ failure which contraindicated retransplantation, died after almost 3 weeks after the appearance of malign arrhythmias. Electrophysiological characteristics of the transplanted heart modify the management of these patients.