Atrial fibrillation originating from recipient left atrium after an orthotopic heart transplantation

Introduction Atrial fibrillation (AF) is rare in patients after orthotopic heart transplantation (OHT) and most commonly has been described in the setting of acute rejection or transplant vasculopathy. The principal reason postulated for the rarity of AF after OHT is the fact that the pulmonary veins and posterior left atrial (LA) wall are isolated as a direct result of the left atrioatrial anastomosis of the remnant LA cuff (which includes the recipient pulmonary veins) to the donor left atrium. Previous reports of late supraventricular tachycardias after OHT have described arrhythmias originating in the recipient atrium and conducting to the donor atrium, but in the vast majority of these reports the arrhythmia is a regular atrial tachycardia or flutter originating from the right atrium (RA).