Related Experiment Videos
Permanent pacing following cardiac transplantation
M M Cooper1, C R Smith, E A Rose
1Department of Surgery, Columbia-Presbyterian Medical Center, Columbia University College of Physicians and Surgeons, New York, N.Y.
The Journal of Thoracic and Cardiovascular Surgery
|September 1, 1992
Summary
Permanent pacemaker insertion is safe and effective for heart transplant recipients, primarily for sinus node dysfunction. Pacing needs may indicate rejection, requiring careful patient evaluation and potentially favoring single-chamber pacing.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Permanent pacemakers are sometimes required after orthotopic cardiac transplantation.
- Understanding the indications, timing, and outcomes of pacemaker insertion is crucial for managing these patients.
Purpose of the Study:
- To evaluate the safety and efficacy of permanent pacemaker insertion in patients following orthotopic cardiac transplantation.
- To identify the primary indications for pacemaker implantation and associated pacing modes.
- To explore the relationship between pacemaker insertion, rejection episodes, and long-term outcomes.
Main Methods:
- Retrospective analysis of 439 patients who underwent orthotopic cardiac transplantation between 1980 and the study period.
- Identification of patients (20) who received permanent pacemakers post-transplant.
- Review of indications for pacing, pacing modes used, and patient outcomes, including survival and resolution of conduction abnormalities.
Main Results:
- Permanent pacemakers were implanted in 20 of 439 cardiac transplant recipients, with 80% within the first month post-transplant.
- Sinus node dysfunction (bradycardia or arrest) was the predominant indication (75%), followed by heart block.
- No pacing-related morbidity or mortality was observed; 70% of patients were alive and well at a mean follow-up of 24 months. Pacing needs may correlate with rejection episodes.
- Sinoatrial node dysfunction improved or resolved in over half of affected patients, while atrioventricular node dysfunction resolved in one of two.
Conclusions:
- Permanent pacemaker implantation is a safe procedure in orthotopic cardiac transplant recipients, mainly indicated for sinus node dysfunction.
- The need for pacing may signal ongoing or new-onset rejection, necessitating thorough patient evaluation.
- Dual-chamber pacing is generally not required unless atrioventricular node dysfunction is present; single-chamber pacing (AAI,R) may be preferred for active patients.