Heart rate and late mortality in cardiac transplant recipients

There are currently 104 patients at this centre who have survived at least 3 months after orthotopic cardiac transplantation. Seven of these long-term survivors have subsequently died and in three cases death was sudden and unexpected. All three of these patients had been noted to have inappropriately high resting heart 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 recorded from ECGs taken at routine follow-up visits every 3 months for one year and annually thereafter. The overall mean heart rate was 100 +/- 13.2 b.min-1. Four patients, including the three identified above, had mean heart rates greater than the 95th centile. The mortality rate in this group is 75%. Four deaths have occurred in the remaining 100 patients (P < 0.001). In our series, an inappropriately high resting heart rate due to sinus tachycardia or supraventricular tachycardia in long-term survivors of cardiac transplantation, is an adverse prognostic sign.