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Challenges in Clinical Electrocardiography
May 20, 2019

Dual Sinus Nodes With Donor Sinus Node Dysfunction in Biatrial Heart Transplantation

Author Affiliations
  • 1California Pacific Medical Center, San Francisco
  • 2Department of Advanced Heart Failure and Transplant Cardiology, California Pacific Medical Center, San Francisco
  • 3Atrial Fibrillation and Complex Arrhythmia Center, California Pacific Medical Center, San Francisco
JAMA Intern Med. Published online May 20, 2019. doi:10.1001/jamainternmed.2019.0640

A man in his 70s with a history of orthotopic heart transplant presented with dizziness. The heart transplantation had been performed using the biatrial surgical technique to treat advanced dilated cardiomyopathy. His posttransplant course was notable for grade 1 cardiac allograft vasculopathy, toxic multinodular goiter status postthyroidectomy, and associated tremors treated with propranolol. At presentation, the patient reported new-onset dizziness that occurred while sitting. He recalled episodes of near-syncope but no loss of consciousness. Two weeks prior to this visit, his cardiologist had measured a low blood pressure and stopped amlodipine treatment, after which symptoms improved. At presentation, he was normotensive, and cardiac examination and electrocardiogram (ECG) results were unremarkable. He was prescribed a 14-day Zio XT (iRhythm Technologies) continuous ambulatory ECG monitor (Figure).

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