• Kathleen T Hickey, Robert R Sciacca, Belinda Chen, Barbara J Drew, David Pickham, Erik V Carter, Carmen Castillo, and Lynn V Doering.
• Kathleen T. Hickey is a professor of nursing, Columbia University School of Nursing, and a nurse practitioner, Columbia University Division of Cardiology, New York, New York. Robert R. Sciacca is a statistician, and Carmen Castillo is a clinical research coordinator, Columbia University School of Nursing. Belinda Chen is a project director and Lynn V. Doering is a professor of nursing, University of California, Los Angeles, School of Nursing, Los Angeles, California. Barbara J. Drew is a professor of nursing, University of California, San Francisco, School of Nursing, San Francisco, California. David Pickham is a clinical assistant professor, Stanford University School of Medicine, Stanford, California. Erik V. Carter is an assistant professor, Wayne State University, Detroit, Michigan. kth6@columbia.edu.
• Am. J. Crit. Care. 2018 Mar 1; 27 (2): 145-150.

BackgroundAcute allograft rejection appears to be associated with increases in QT/QTc intervals.ObjectivesTo determine the relationship between acute allograft rejection and electrocardiogram changes in patients undergoing an orthotopic heart transplant.MethodsThe study population comprised 220 adult patients undergoing heart transplant and enrolled in the NEW HEART study. Electrocardiograms obtained within 72 hours of endomyocardial biopsy were analyzed; electrocardiograms obtained fewer than 10 days after transplant surgery were excluded. Repeated-measures analysis was performed with statistical models including effects for rejection severity (mild and moderate/severe) and time trends independent of rejection status.ResultsThe 151 male and 69 female transplant recipients (mean age [SD], 54 [13] years) had 969 biopsy/electrocardiogram pairs: 677 with no rejection, 280 with mild rejection, and 12 with moderate/severe rejection. Moderate to severe organ rejection was associated with significant increases in QRS duration (P < .001), QT (P = .009), QTc (P = .003), and PR interval (P = .03), as well as increased odds of right bundle block branch (P = .002) and fascicular block (P = .009) occurring.ConclusionsModerate to severe acute allograft rejection was associated with electrocardiographic changes after transplant surgery. Studies are needed to assess the value of computerized electrocardiogram measurement algorithms for detecting acute allograft rejection.©2018 American Association of Critical-Care Nurses.

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