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Long-term pacing in heart transplant recipients is usually unnecessary
C D Scott1, I Omar, J M McComb
1Cardiothoracic Centre, Freeman Hospital Newcastle upon Tyne, United Kingdom.
Insights
Permanent pacing is rarely needed in adult heart transplant recipients, primarily for sinus node dysfunction. Rate-responsive pacing does not improve exercise tolerance in these patients.
Area of Science:
- Cardiology
- Transplant Medicine
- Electrophysiology
Background:
- Heart transplant recipients can develop bradyarrhythmias requiring pacemaker implantation.
- Understanding the long-term pacing needs is crucial for patient management.
Purpose of the Study:
- To review indications and timing of permanent pacemaker implantation in adult heart transplant recipients.
- To assess pacing requirements and the effectiveness of different pacing modes.
Main Methods:
- Retrospective review of 17 patients with permanent pacemakers post-transplant.
- Prospective evaluation including Holter monitoring and exercise testing with various pacing modes.
Main Results:
- Sinus node dysfunction (59%) and atrioventricular block (41%) were primary indications for pacing.
- Pacing requirement decreased over time; only 3/154 patients needed long-term pacing.
- Rate-responsive pacing did not enhance exercise capacity.
Conclusions:
- Long-term pacing is uncommon in heart transplant recipients and mainly indicated for sinus node dysfunction.
- Rate-responsive pacing offers no significant benefit for exercise tolerance in this population.
Abstract:
The indications for and timing of permanent pacing were reviewed in all 17 of 154 adult heart transplant recipients at this center who have had permanent pacemakers implanted. Resting 12-lead ECGs recorded during routine follow-up were examined. A prospective study of pacing requirement was then undertaken. Holter monitoring was performed before and after reprogramming the pacemakers to VVI mode at 50 beats/min. Exercise responses in various pacing modes were then assessed in seven patients with rate responsive pacemakers using a standard Bruce protocol treadmill test. The indication for pacing was sinus node dysfunction in 59% (10/17) and atrioventricular (AV) block in 41% (7/17). The majority of pacemakers were implanted between seven and 21 days after transplantation. There was a progressive reduction in the frequency of pacing on 12-lead ECGs with time after transplantation. There was a progressive reduction in the frequency of pacing on 12-lead ECGs with time after transplantation. Eight of 14 patients with empirically selected programming paced during Holter monitoring. After reprogramming to 50 beats/min VVI mode only three of 14 patients, all with sinus node dysfunction, paced. Rate responsive pacing made no difference to exercise time. The requirement for long-term pacing in cardiac transplant recipients is small (3/154) and is limited to patients with sinus node dysfunction. Rate responsive pacing did not increase exercise tolerance.