Comparisons of paired orthotopic cardiac transplant donor and recipient electrocardiograms

Electrocardiograms of 20 consecutive donor and paired recipient orthotopic heart transplant patients were compared. Recipients were markedly older than donors; all patients were males, and both groups had similar body weight. The heart rate was faster, QRS was longer, QT was shorter, QRS axis was more shift to the left, and precordial voltage was decreased in the recipient ECGs in the first 72 hours after transplant. These changes persisted during late follow-up (12 ± 6 months after transplant). Seventy percent and 60% of recipients within the first 72 hours after transplant and during late follow-up, respectively, had a new RBBB delay compared to their paired donor ECG. There was a trend toward less clockwise rotation in the ECGs of patients who had a new incomplete RBBB in the late follow-up compared to patients who did not. Thus new RBBB delays, QT shortening, QRS axis left shift, and decrease in precordial voltage are commonly seen on ECGs after orthotopic cardiac transplantation. A new heart position and recipient's weight do not seem to account for the development of a new RBBB delay and decrease in precordial voltage. Other factors, such as mechanical or thermal injury and change in donor-to-recipient age, may be involved.