Hi Tatiyana

Interesting ECG

There appears to be 2 sets of "P" waves. One set is regular and the rate suggests atrial flutter - these are thus flutter waves and do not appear to be conducted.

The second set are related to the following QRS complex with a short PR interval ~120ms and appear negative in all three leads - this could be a nodal rhythm.

The ventricular rate is ~ 54bpm

Therefore: Background of non-conducted atrial flutter. Nodal rhythm with ventricular rate suggesting this could be an escape rhythm.

Also very tall T waves in lower recording. Electroytes should be checked to exclude hyperkalcaemia.

Tony

Sinus rhythm. The patient probably still have his/hers original atria (or part of them) they are in atrial flutter/tachycardia and the donor heart has sinus rhythm. Since the patients atrial flutter is not conducted due to the incision line, it would be most correct to call it sinus rhythm

I'm thinking like Dr Kanters.

For the orthotopic heart transplantation, we preserve a small margin of the patient original atria to help with the anastomosis and prevent bleeding.

Do you have the ECG before heart transplantation? The patient could had big chambers and atrial flutter/fibrillation as base rhythm.

Hi,Vinícius Eduardo. You're right! The patient had a dilated chambers and atrial flutter/fibrillation baseline, Nevertheless, what is rhythm in the donor atrium? Are really all the same sinus rhythm? Negative P wave... A shortening of PR interval....

Hi Dr Tatiyana.

About a negative (or inverted) P wave: it can be an ectopic atrial rhythm. During organ harvesting, the sinus node can be damaged (not all surgery teams preserve superior vena cava, and sometimes it can be damaged).

So, we have the patient original P (in this case, an "F" wave), and donor's heart ectopic atrial rhythm.

What do you think?

Best regards,

Dear Colleagues. Thank you everybody. I agree with you and I think, too, that in the remaining part of the recipient`s atria there is atrial fibrillation/flutter while the donor atrium escaping ectopic inferior-atrial (perhaps nodal) rhythm.

Dear Tony! Dear Vinícius Eduardo! You are absolutely correct that the donor heart is compromised as evidenced by the chronotropic incompetence of the sinus node and the expressed disturbances of repolarization (ST-T).

Best regards