Permanent pacemaker for syncope after heart transplantation with bicaval technique

Area of Science:

• Cardiology
• Transplantation Medicine
• Electrophysiology

Background:

• Sinus node dysfunction (SND) is an occasional complication following heart transplantation.
• Potential causes include surgical trauma, ischemia, rejection, medications, and donor age.
• The optimal timing and indications for permanent pacemaker insertion in these patients remain debated.

Observation:

• This report details a heart transplant recipient who developed syncope due to sinus arrest.
• The patient underwent permanent pacemaker insertion despite the use of the bicaval technique.
• The bicaval technique is generally associated with a lower incidence of sinus node dysfunction.

Findings:

• Permanent pacemaker implantation was required for symptomatic sinus arrest post-heart transplantation.
• This occurred despite the utilization of the bicaval surgical approach.
• The case underscores that SND can manifest even with techniques aimed at preserving sinus node function.

Implications:

• This case contributes to the discussion on managing sinus node dysfunction after heart transplantation.
• It suggests that careful monitoring and consideration for pacing are necessary, irrespective of surgical technique.
• Further research may clarify specific criteria for pacemaker implantation in this patient population.