Noninvasive detection of cardiac transplant rejection using electronic monitoring.

Cardiac transplantation has become the therapy of choice for the treatment of end-stage congestive heart failure. One of the major problems after cardiac transplantation is acute cellular rejection. The diagnosis of rejection is crucial to the management of transplant patients because rejection must be successfully diagnosed and reversed. Endomyocardial biopsy is the major method for detecting cardiac transplant rejection; however, this approach is invasive and is associated with morbidity and mortality. One noninvasive approach for detecting rejection is to monitor changes in the intramyocardial electrograms using pacemakers. Changes in the ventricular evoked response amplitude (VERA) obtained during ventricular pacing have been correlated with the presence of acute cellular rejection in both single center studies in Europe and a multicenter trial in five transplant centers in the United States. Given the high negative predictive value for the VERA, this approach may provide a screen to determine if individual patients require more invasive procedures such as endomyocardial biopsy and may aid in reducing the number of biopsies needed.