{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:47:19Z","timestamp":1791838039952,"version":"4.3.4"},"reference-count":55,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100007914","name":"UT Southwestern","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007914","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","heartrhythmjournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Heart Rhythm"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.hrthm.2026.08.056","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T14:59:32Z","timestamp":1788533972000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Catheter ablation of atrial arrhythmias after orthotopic heart transplantation"],"prefix":"10.1016","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1766-0202","authenticated-orcid":false,"given":"Deena","family":"Sukhon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nolan","family":"Shoukri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2103-2981","authenticated-orcid":false,"given":"Frans","family":"Serpa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Deshmukh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishaki","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamala P.","family":"Tamirisa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.hrthm.2026.08.056_bib1","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1016\/j.jacc.2008.02.065","article-title":"Supraventricular tachycardia after orthotopic cardiac transplantation","volume":"51","author":"Vaseghi","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib2","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.120.007954","article-title":"Management of arrhythmias after heart transplant: current state and considerations for future research","volume":"14","author":"Joglar","year":"2021","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib3","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ccep.2024.10.002","article-title":"Atrial fibrillation incidence, outcomes, and management in patients with left ventricular assist devices and orthotopic heart transplants","volume":"17","author":"Allam","year":"2025","journal-title":"Card Electrophysiol Clin"},{"key":"10.1016\/j.hrthm.2026.08.056_bib4","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1111\/j.1540-8167.2006.00497.x","article-title":"Incidence of atrial fibrillation in heart transplant patients: long-term follow-up","volume":"17","author":"Khan","year":"2006","journal-title":"J Cardiovasc Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib5","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.ccep.2012.05.006","article-title":"Atrial tachyarrhythmias after cardiac transplantation","volume":"4","author":"Cantillon","year":"2012","journal-title":"Card Electrophysiol Clin"},{"key":"10.1016\/j.hrthm.2026.08.056_bib6","article-title":"Atrial fibrillation after orthotopic heart transplantatation: pathophysiology and clinical impact","volume":"32","author":"Ferretto","year":"2021","journal-title":"Int J Cardiol Heart Vasc"},{"key":"10.1016\/j.hrthm.2026.08.056_bib7","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.jaccas.2019.06.026","article-title":"A tale of 2 hearts: simultaneous dual tachycardias occurring 22 years after orthotopic heart transplantation","volume":"1","author":"Ali","year":"2019","journal-title":"JACC Case Rep"},{"key":"10.1016\/j.hrthm.2026.08.056_bib8","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/j.1540-8167.1995.tb00427.x","article-title":"Radiofrequency ablation of a supraventricular tachycardia due to interatrial conduction from the recipient to donor atria in an orthotopic heart transplant recipient","volume":"6","author":"Rothman","year":"1995","journal-title":"J Cardiovasc Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib9","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1111\/j.1540-8167.1996.tb00485.x","article-title":"Radiofrequency catheter ablation of atrial flutter after orthotopic heart transplantation","volume":"7","author":"Li","year":"1996","journal-title":"J Cardiovasc Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib10","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/S0735-1097(97)00186-1","article-title":"Mechanism and location of atrial flutter in transplanted hearts: observations during transient entrainment from distant sites","volume":"30","author":"Arenal","year":"1997","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib11","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1136\/hrt.79.4.412","article-title":"Radiofrequency catheter ablation for atrial flutter following orthotopic heart transplantation","volume":"79","author":"Pitt","year":"1998","journal-title":"Heart"},{"key":"10.1016\/j.hrthm.2026.08.056_bib12","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/S0735-1097(98)00360-X","article-title":"Catheter ablation of atrioatrial conduction as a cure for atrial arrhythmia after orthotopic heart transplantation","volume":"32","author":"Saoudi","year":"1998","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib13","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/S1053-2498(98)00047-3","article-title":"Radiofrequency catheter ablation of atrial flutter after orthotopic heart transplantation: insights into the redefined critical isthmus","volume":"18","author":"Pinski","year":"1999","journal-title":"J Heart Lung Transplant"},{"key":"10.1016\/j.hrthm.2026.08.056_bib14","first-page":"613","article-title":"[Atrial flutter: a possible early sign of acute rejection in heart transplantation. A case report]","volume":"94","author":"Boveda","year":"2001","journal-title":"Arch Mal Coeur Vaiss"},{"key":"10.1016\/j.hrthm.2026.08.056_bib15","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1046\/j.1460-9592.2002.01262.x","article-title":"Catheter ablation of atrial flutter in a heart transplant recipient","volume":"25","author":"Krishnan","year":"2002","journal-title":"Pacing Clin Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib16","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/S1053-2498(01)00770-7","article-title":"Atrial tachycardia with recipient-to-donor atrioatrial conduction and isthmus-dependent donor atrial flutter in a patient after orthotopic heart transplantation. Successful treatment by radiofrequency catheter ablation","volume":"21","author":"Fournet","year":"2002","journal-title":"J Heart Lung Transplant"},{"key":"10.1016\/j.hrthm.2026.08.056_bib17","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1046\/j.1460-9592.2003.00284.x","article-title":"Catheter ablation of supraventricular tachycardia in the transplanted heart: a case series and literature review","volume":"26","author":"Magnano","year":"2003","journal-title":"Pacing Clin Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib18","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1046\/j.1540-8167.2004.04440.x","article-title":"Catheter ablation of atrial flutter after orthotopic heart transplantation","volume":"15","author":"Heist","year":"2004","journal-title":"J Cardiovasc Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib19","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/j.1540-8159.2005.40019.x","article-title":"Mechanism of atrial flutter occurring late after orthotopic heart transplantation with atrio-atrial anastomosis","volume":"28","author":"Marine","year":"2005","journal-title":"Pacing Clin Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib20","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.1097\/00029330-200612020-00003","article-title":"Radiofrequency catheter ablation in patients with symptomatic atrial flutter\/tachycardia after orthotopic heart transplantation","volume":"119","author":"Li","year":"2006","journal-title":"Chin Med J (Engl)"},{"key":"10.1016\/j.hrthm.2026.08.056_bib21","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.healun.2005.07.017","article-title":"Prevalence, pathophysiology, and clinical significance of post-heart transplant atrial fibrillation and atrial flutter","volume":"25","author":"Ahmari","year":"2006","journal-title":"J Heart Lung Transplant"},{"key":"10.1016\/j.hrthm.2026.08.056_bib22","doi-asserted-by":"crossref","first-page":"2697","DOI":"10.1016\/j.transproceed.2010.04.067","article-title":"Atrial flutter after heart transplantation: mechanism and catheter ablation","volume":"42","author":"Rodr\u00edguez-Entem","year":"2010","journal-title":"Transplant Proc"},{"key":"10.1016\/j.hrthm.2026.08.056_bib23","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1093\/europace\/eus092","article-title":"Supraventricular arrhythmias late after orthotopic cardiac transplantation: electrocardiographic and electrophysiological characterization and radiofrequency ablation","volume":"14","author":"Elsik","year":"2012","journal-title":"Europace"},{"key":"10.1016\/j.hrthm.2026.08.056_bib24","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/jce.12078","article-title":"Catheter ablation of atrial arrhythmias after cardiac transplantation: findings at EP study utility of 3-D mapping and outcomes","volume":"24","author":"Nof","year":"2013","journal-title":"J Cardiovasc Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib25","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.hrcr.2017.10.002","article-title":"Atrial fibrillation originating from recipient left atrium after an orthotopic heart transplantation","volume":"3","author":"Badin","year":"2017","journal-title":"HeartRhythm Case Rep"},{"key":"10.1016\/j.hrthm.2026.08.056_bib26","article-title":"Catheter ablation of organized atrial arrhythmias in orthotopic heart transplantation","author":"Mouhoub","year":"2017","journal-title":"J Heart Lung Transplant"},{"key":"10.1016\/j.hrthm.2026.08.056_bib27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.hrcr.2019.09.011","article-title":"Atrial arrhythmia in a patient after bicaval heart transplantation: evidence for recipient-to-donor conduction","volume":"6","author":"Hayek","year":"2020","journal-title":"HeartRhythm Case Rep"},{"key":"10.1016\/j.hrthm.2026.08.056_bib28","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.120.008751","article-title":"Immuno-electrophysiological mechanisms of functional electrical connections between recipient and donor heart in patients with orthotopic heart transplantation presenting with atrial arrhythmias","volume":"14","author":"Herweg","year":"2021","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib29","doi-asserted-by":"crossref","DOI":"10.1111\/ctr.14429","article-title":"A retrospective evaluation of catheter ablation in atrial flutter post cardiac transplantation","volume":"35","author":"Taylor","year":"2021","journal-title":"Clin Transpl"},{"key":"10.1016\/j.hrthm.2026.08.056_bib30","doi-asserted-by":"crossref","DOI":"10.1111\/ctr.14165","article-title":"Radiofrequency ablation of supraventricular arrhythmias after orthotopic heart transplantation: long-term follow-up of a single-center experience","volume":"35","author":"Renedo","year":"2021","journal-title":"Clin Transpl"},{"key":"10.1016\/j.hrthm.2026.08.056_bib31","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3390\/jcdd9100337","article-title":"Frequency, risk factors, and clinical outcomes of late-onset atrial flutter in patients after heart transplantation","volume":"9","author":"Rahm","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"key":"10.1016\/j.hrthm.2026.08.056_bib32","doi-asserted-by":"crossref","first-page":"e959","DOI":"10.1016\/j.hrthm.2025.05.060","article-title":"A novel approach to treat atrial tachycardia by catheter ablation in patients after orthotopic biatrial heart transplantation: the L-line","volume":"22","author":"Khalaph","year":"2025","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hrthm.2026.08.056_bib33","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1007\/s10840-025-02083-y","article-title":"AI-guided spatiotemporal dispersion mapping for individualized ablation in an all-comer cohort with atrial fibrillation","volume":"68","author":"Heil","year":"2025","journal-title":"J Interv Card Electrophysiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib34","doi-asserted-by":"crossref","first-page":"287","DOI":"10.2147\/TCRM.S126869","article-title":"The influence of surgical technique on early posttransplant atrial fibrillation - comparison of biatrial, bicaval, and total orthotopic heart transplantation","author":"Rivinius","year":"2017","journal-title":"Ther Clin Risk Manag"},{"key":"10.1016\/j.hrthm.2026.08.056_bib35","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/HCO.0b013e3280125472","article-title":"Tricuspid valve replacement after cardiac transplantation","volume":"22","author":"Badiwala","year":"2007","journal-title":"Curr Opin Cardiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib36","first-page":"690","article-title":"Operative technique and atrial tachyarrhythmias after orthotopic heart transplantation","volume":"5","author":"Sattiraju","year":"2012","journal-title":"J Atr Fibrillation"},{"key":"10.1016\/j.hrthm.2026.08.056_bib37","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/0735-1097(94)90561-4","article-title":"Atrioatrial conduction after orthotopic heart transplantation","volume":"24","author":"Anselme","year":"1994","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib38","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/S0002-9149(98)00359-2","article-title":"Recipient-to-donor atrioatrial conduction after orthotopic heart transplantation: surface electrocardiographic features and estimated prevalence","volume":"82","author":"Lefroy","year":"1998","journal-title":"Am J Cardiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib39","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.healun.2007.01.015","article-title":"Recipient atrial flutter masquerading as donor flutter in a heart transplant recipient","volume":"26","author":"Karim","year":"2007","journal-title":"J Heart Lung Transplant"},{"key":"10.1016\/j.hrthm.2026.08.056_bib40","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.ipej.2025.08.003","article-title":"A high-resolution mirage: navigating atrial flutter circuits in the era of automated mapping","volume":"25","author":"Patil","year":"2025","journal-title":"Indian Pacing Electrophysiol J"},{"key":"10.1016\/j.hrthm.2026.08.056_bib41","doi-asserted-by":"crossref","first-page":"4265","DOI":"10.1002\/ehf2.13552","article-title":"Atrial fibrillation before heart transplantation is a risk factor for post-transplant atrial fibrillation and mortality","volume":"8","author":"Darche","year":"2021","journal-title":"ESC Heart Fail"},{"key":"10.1016\/j.hrthm.2026.08.056_bib42","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1016\/j.jacc.2009.08.029","article-title":"A comparison of atrial arrhythmias after heart or double-lung transplantation at a single center: insights into the mechanism of post-operative atrial fibrillation","volume":"54","author":"Dizon","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib43","doi-asserted-by":"crossref","DOI":"10.1111\/ctr.15254","article-title":"A retrospective analysis of anticoagulant safety among heart transplant recipients undergoing endomyocardial biopsy","volume":"38","author":"Stock","year":"2024","journal-title":"Clin Transpl"},{"key":"10.1016\/j.hrthm.2026.08.056_bib44","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0022-5223(19)34410-1","article-title":"Evaluation of patients at risk for protamine reactions","volume":"98","author":"Levy","year":"1989","journal-title":"J Thorac Cardiovasc Surg"},{"key":"10.1016\/j.hrthm.2026.08.056_bib45","doi-asserted-by":"crossref","first-page":"2828","DOI":"10.1182\/blood-2012-11-469130","article-title":"High incidence of antibodies to protamine and protamine\/heparin complexes in patients undergoing cardiopulmonary bypass","volume":"121","author":"Lee","year":"2013","journal-title":"Blood"},{"key":"10.1016\/j.hrthm.2026.08.056_bib46","article-title":"Anaphylactic reaction to protamine sulfate: a case report","volume":"16","author":"David do Carmo","year":"2024","journal-title":"Cureus"},{"key":"10.1016\/j.hrthm.2026.08.056_bib47","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.3390\/jcm14041346","article-title":"Care of adult heart transplant recipients by the primary care provider: a practical roadmap","volume":"14","author":"Wu","year":"2025","journal-title":"J Clin Med"},{"key":"10.1016\/j.hrthm.2026.08.056_bib48","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.hrcr.2021.10.010","article-title":"Two hearts beating out of time: mapping and ablation of concurrent atrial fibrillation and macroreentrant left atrial flutter in a transplanted heart","volume":"8","author":"Choudhury","year":"2022","journal-title":"HeartRhythm Case Rep"},{"key":"10.1016\/j.hrthm.2026.08.056_bib49","first-page":"564","article-title":"Amiodarone-cyclosporine interaction in a heart transplant patient","volume":"11","author":"Nicolau","year":"1992","journal-title":"J Heart Lung Transplant"},{"key":"10.1016\/j.hrthm.2026.08.056_bib50","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1080\/17512433.2019.1637733","article-title":"Drug interactions between direct-acting oral anticoagulants and calcineurin inhibitors during solid organ transplantation: considerations for therapy","volume":"12","author":"Lam","year":"2019","journal-title":"Expert Rev Clin Pharmacol"},{"key":"10.1016\/j.hrthm.2026.08.056_bib51","doi-asserted-by":"crossref","first-page":"4334","DOI":"10.3390\/jcm12134334","article-title":"Oral anticoagulants after heart transplantation-comparison between vitamin K antagonists and direct oral anticoagulants","volume":"12","author":"Darche","year":"2023","journal-title":"J Clin Med"},{"key":"10.1016\/j.hrthm.2026.08.056_bib52","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1111\/j.1399-3046.2006.00561.x","article-title":"Amiodarone-sirolimus\/tacrolimus interaction in a pediatric heart transplant patient","volume":"10","author":"Nalli","year":"2006","journal-title":"Pediatr Transplant"},{"key":"10.1016\/j.hrthm.2026.08.056_bib53","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1517\/14740338.2016.1132698","article-title":"Safety of mTOR inhibitors in adult solid organ transplantation","volume":"15","author":"Ventura-Aguiar","year":"2016","journal-title":"Expert Opin Drug Saf"},{"key":"10.1016\/j.hrthm.2026.08.056_bib54","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1177\/106002809202601216","article-title":"Over-the-counter medications in cardiac transplant recipients: guidelines for use","volume":"26","author":"Lake","year":"1992","journal-title":"Ann Pharmacother"},{"key":"10.1016\/j.hrthm.2026.08.056_bib55","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1056\/NEJMoa010519","article-title":"Effect of sympathetic reinnervation on cardiac performance after heart transplantation","volume":"345","author":"Bengel","year":"2001","journal-title":"N Engl J Med"}],"container-title":["Heart Rhythm"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1547527126027608?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1547527126027608?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:04:17Z","timestamp":1791835457000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1547527126027608"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":55,"alternative-id":["S1547527126027608"],"URL":"https:\/\/doi.org\/10.1016\/j.hrthm.2026.08.056","relation":{},"ISSN":["1547-5271"],"issn-type":[{"value":"1547-5271","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Catheter ablation of atrial arrhythmias after orthotopic heart transplantation","name":"articletitle","label":"Article Title"},{"value":"Heart Rhythm","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.hrthm.2026.08.056","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Published by Elsevier Inc. on behalf of Heart Rhythm Society.","name":"copyright","label":"Copyright"}]}}