October 1986

Two Hearts in One Chest

Author Affiliations

From the Departments of Medicine (Dr Curtiss) and Surgery (Dr Griffith), University of Pittsburgh School of Medicine and Presbyterian-University Hospital, Pittsburgh.

Arch Intern Med. 1986;146(10):2037-2039. doi:10.1001/archinte.1986.00360220207033

Approached in isolation, the interpretation of electrocardiographic rhythm strips can present problems of extraordinary complexity. The rhythm strip in Fig 1 that shows simultaneous recordings of leads V1, II, and V5 provides a unique example. The underlying atrial rhythm appears to be fibrillation. There are both wide and narrow QRS complexes apparently dissociated from one another with a pacemaker spike (indicated by the arrow) preceding the latter by an appreciable, fixed interval. While this degree of complexity is of a high order, it, nevertheless, underscores the interpretation problem in patients who undergo cardiac transplantation. In the usual (or orthotopic) type of transplant, donor and native atria are surgically joined with both sinus nodes remaining intact. There is only a single set of ventricles, those of the donor. Since arrhythmias of the donor heart may be a valuable clue to rejection, it is necessary to distinguish donor and native

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