Heart rate and late mortality in cardiac transplant recipients

There are currently 104 patients at this centre who have survivedat least 3 months after orthotopic cardiac transplantation.Seven of these long-term survivors have subsequently died andin three cases death was sudden and unexpected. All three ofthese patients had been noted to have inappropriately high restingheart rates (>130 b.min^–1) The rhythm was sinus tachycardia,supraventricular tachycardia or both intermittently. The heart rates of all 104 long-term survivors were recordedfrom ECGs taken at routine follow-up visits every 3 months forone year and annually thereafter. The overall mean heart ratewas 100±13.2 b.min^–1. Four patients, including the three identified above, had meanheart rates greater than the 95th centile. The mortality ratein this group is 75%. Four deaths have occurred in the remaining100 patients (P <0.001). In our series, an inappropriately high resting heart rate dueto sinus tachycardia or supraventricular tachycardia in long-termsurvivors of cardiac transplantation, is an adverse prognosticsign.