Introduction. Computerized Heart Allograft Rejection Monitoring (CHARM), used for noninvasive rejection monitoring in heart transplant recipients, is based on the analysis of ventricular evoked response (VER) signals. This study evaluated the prognostic validity of the Tslew(C), a parameter extrapolated from the VER.Methods. During orthotopic heart transplantation (OHT) 2 unipolar, fractally coated, screw-in leads implanted epimyocardially were connected to a telemetric pacemaker. Recordings of IEGMs were performed routinely at hospital and at outpatient visits. Data processing yielded trend curves. Tslew(C) was calculated from the tangent of VER. One hundred five patients divided into survivors and nonsurvivors, were compared using a two-tailed Student's t test.Results. In the final follow-up a significant lower Tslew(C) was observed among patients in the nonsurvivor compared with the other group (P <.001). Tests to find an optimal prognostic threshold of the Tslew(C) yielded the value of 26 mV.Conclusion. Tslew(C) functioned as a prognostic factor after OHT. Further studies must provide a prognostic threshold to avoid patient visits all 4 weeks. Patients would only have to be admitted to the hospital if the Tslew(C) was under this prognostic threshold.

Introduction Computerized heart allograft rejection monitoring (CHARM) used for non-invasive rejection monitoring in heart transplant recipients is based on the analysis of ventricular evoked response (VER) signals. The aim of this study was to evaluate the prognostic validity of the TslewC, a parameter calculated from the VER. Methods During orthotopic heart transplantation, 2 unipolar fractally coated screw-in leads were implanted epimyocardially, one to the left and one to the right ventricle, and connected to a telemetric pacemaker. Recordings of intramyocardial electrograms were performed routinely at the hospital. Data processing was done, artifacts were eliminated, and trend curves of the patients were displayed. TslewC was calculated from the tangent of VER and evaluated from 105 patients. The patients were divided into survivor and non-survivor groups. For statistical analysis, the 2-tailed t-test was performed. Results Patients in the non-survivors group compared with the control group showed a significantly lower TslewC in the final follow-up (p < 0.001). The differences were even more impressive in patients with recorded intramyocardial electrograms 30 days before death or with a cardiac reason for death. Tests were performed to find an optimal prognostic threshold of the TslewC, and the value of 26 mV was finally found. Conclusion TslewC can function as prognostic factor after orthotopic heart transplantation. Further studies should be initiated to provide the prognostic threshold so that patients would not be forced to show up routinely every 4 weeks for follow-up visits. Patients would only have to be admitted to the hospital if the TslewC were less than this prognostic threshold.