Specific electrophysiological properties of transplanted heart are caused mainly by complex surgery, suppression of autonomic innervation, and allograft rejection. Interpretation of ECG may be difficult because of two P waves. The other most prevalent ECG abnormalities are: incomplete or complete right bundle branch block, shift of QRS axis to the left, shorter QT interval, decreased precordial voltage. The influence of denervation is apparent in: higher basic heart rate, chronotropic dysfunction, different responsiveness to various cardiac drugs, susceptibility to fatal ventricular arrhythmias. The prevalence of bradyarrhythmias and tachyarrhythmias is higher than in other population. Many of them correlate with acute or chronic cardiac rejection. It is desirable to utilize specific electrophysiological properties for noninvasive detection of allograft rejection.
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