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Permanent pacing for late-onset atrioventricular block in patients with heart transplantation: a single center
Andre E Tay1, Steven Faddy, Sern Lim
1Department of Cardiology and Cardiac Electrophysiology, St Vincent's Hospital, Sydney, Australia.
Insights
Late-onset atrioventricular (AV) block affects 2.4% of heart transplant recipients. This intermittent condition typically does not progress to permanent AV block and has no predictable onset factors.
Area of Science:
- Cardiology
- Transplantation Medicine
- Electrophysiology
Background:
- Late-onset atrioventricular (AV) block post-heart transplantation remains poorly understood.
- Characterizing its incidence, mechanisms, and outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the incidence and characteristics of late-onset AV block following cardiac transplantation.
- To identify potential risk factors and clinical associations of this complication.
Main Methods:
- Retrospective review of patient databases from January 1990 to December 2007.
- Analysis of patients requiring pacemakers for late-onset AV block after orthotopic heart and heart-lung transplantation.
- Separate analysis of orthotopic heart and heart-lung transplant procedures.
Main Results:
- Of 519 orthotopic heart transplants, 11 (2.1%) developed late-onset AV block requiring pacing.
- Three (4.7%) of 64 heart-lung transplants experienced late-onset AV block requiring pacing.
- No heterotopic heart transplant patients required pacing for AV block.
Conclusions:
- Late-onset AV block occurs in 2.4% of orthotopic heart and heart-lung transplant recipients.
- AV block is predominantly intermittent and often does not progress to permanent AV block.
- No predictable factors were identified for the onset of late-onset AV block.
Introduction:
The incidence, mechanisms, clinical associations, and outcomes in patients with late-onset (>3 months) atrioventricular (AV) block following heart transplantation are not well known. This study will characterize late-onset AV block following cardiac transplantation.
Methods:
We retrospectively reviewed our databases to identify patients who required pacemakers for late-onset AV block postheart and heart-lung transplantation from January 1990 to December 2007. Orthotopic heart and heart-lung transplantation were separately analyzed.
Results:
This study included 588 adults who received cardiac transplants over a 17-year period at our center (519 orthotopic, 64 heart-lung transplants, and five heterotopic heart transplants). Of the 519 patients with orthotopic heart transplant, 39 required pacing (7.5%), 17 (3.3%) within 3 months posttransplant, 11 (2.1%) for late-onset sinus node dysfunction (SND), 11 (2.1%) for late-onset AV block. Also, five patients (7.8%) out of 64 heart-lung transplants required pacemakers, two (3.1%) for late-onset SND, three (4.7%) for late-onset AV block. None of the five patients who underwent heterotopic transplant required cardiac pacing prior to or posttransplant.
Conclusions:
Late-onset AV block occurs in 2.4% of patients with orthotopic heart transplant or heart-lung transplant. AV block is predominantly intermittent and, often, does not progress to permanent AV block. There are no predictable factors for its onset.
