The article "Asystole in a Heart Transplant Recipient" (Action Stat, April 2004) reminded me of something I learned years ago about heart transplantation. I seem to remember that the ECG could show two p waves-one from the donor heart and one from the patient's original sinoatrial node, depending on how much original tissue remained near the valve. Is this "old school," or still valid?

DEBBIE FIEGLE, RN, CCRN, MS

Highland, Ind.

The author responds: You're correct that in some recipients, native atrial tissue remains. A patient who's undergone an orthotopic cardiac transplant may retain residual remnants of his native right and left atria. If so, the ECG may occasionally show two autonomous atrial depolarizations. "Occasionally" is the key word because this doesn't occur consistently.

Don't confuse this with a heterotopic cardiac transplant, which rarely is performed anymore. A heterotopic transplant involves implanting a donor heart into the recipient's chest and connecting it to the recipient's heart, where it functions as a biologic ventricular assist device. After this procedure, the ECG may show two ECG rhythms.

Elisabeth L. George, RN, CCRN, PhD

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